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MEKAR (MEK Inhibitor Associated Retinopathy) Multifocal yellow-grey elevations of the fundus (typically circular, without inferior fluid tracking)See: https://www.retinarevealed.com/case-64-gravitational-tracks-in-bilateral-central-serous-chorioretinopathy-page-1-of-20/Typically bilateral, can be unilateral (rare)~50% of patients may be symptomatic with vision loss no more than 2 Snellen lines of acuity from baseline (and returns to within 1 line of baseline after fluid

Back to our patient…Treatment: OBSERVATION (patient continues on MEK Inhibitor)Follow-up 2 weeks later: nearly all fluid has resolved corresponding to improvement in vision BCVA: 20/20 BCVA: 20/20

Now an OCT with fluid accumulation:Ellipsoid zoneRPEIZ (easier to visualize with presence of fluid)

Let’s RECAP our retinal landmarks on a normal OCT:External Limiting membrane (ELM)Ellipsoid zone/PILIZ (intimate with RPE)RPE

OCT gives us two clues:We can see “bubbles” of fluid on the IR imageScan through the retina helps to identify fluid between the interdigitation zone (IZ) and retinal pigment epithelium (RPE)

Color fundus images do not reveal any obvious reason for vision decline BCVA: 20/40IOP: 11mmHg BCVA: 20/25-2IOP: 12mmHg

Background 55 y/o M with complaints of blurred vision after each cancer treatment that resolves within a few days. He had two prior cycles of treatment and experienced the same vision symptoms each time. PMH: Recurrent cutaneous melanoma on dabrafenib (BRAF Inhibitor) and trametinib (MEK Inhibitor)

MEK-Inhibitor Associated Retinopathy (MEKAR) Targeted cancer therapies can cause ocular toxicityIt is important to distinguish these ocular toxicities from other ocular conditions. For example: central serous chorioretinopathy (CSR)These cases can be observed without the need for intervention (and often continued on life-saving cancer treatment)