A rare case of pemetrexed-induced diffuse punctal and canalicular stenosis: management by coronary balloon puncto-canaliculoplasty

Our plain-English summary of A rare case of pemetrexed-induced diffuse punctal and canalicular stenosis: management by coronary balloon puncto-canaliculoplasty, by A. Sharma, M. Pattnaik, M.J. Ali (Orbit, 2022).

The study

• Authors: A. Sharma, M. Pattnaik, M.J. Ali
• Journal: Orbit
• Published: 2022;41(6):763-765
• Type of article: Case report
• Cited by: 9 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Several chemotherapeutic agents are known to induce lacrimal drainage stenosis and obstruction, resulting in epiphora. Pemetrexed is one such drug and is used in the management of mesotheliomas and non-small cell lung carcinomas. Pemetrexed inhibits folate metabolism at multiple levels. The present case is the second report of pemetrexed induced punctal and canalicular stenosis, but the first to document dacryoendoscopy findings and report balloon puncto-canaliculoplasty as a minimally-invasive treatment option.

In plain English

This article is a case report about one patient at an eye institute in Hyderabad, India. It does not concern asbestos. The patient, a 60-year-old man, had stage IV non-small cell lung carcinoma, not mesothelioma. The authors note that his chemotherapy drug, pemetrexed, is also approved for treating pleural mesothelioma. After four cycles of pemetrexed (870 mg), he developed watering of both eyes (epiphora). It worsened with each later cycle, reaching grade 5 on the Munk epiphora scale. All four tear-drainage openings (puncta) were severely narrowed. A camera examination of the drainage channels (dacryoendoscopy) showed diffuse narrowing of the canaliculi without blockage. Under local anesthesia, doctors widened all four with a coronary angioplasty balloon and placed a small stent for four weeks. The watering resolved (Munk scale 0 to 1), with no recurrence for up to 6 months after the operation. The authors described this as the second reported case of pemetrexed-induced punctal and canalicular stenosis. They concluded that it was successfully managed by non-incisional, minimally invasive methods.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: case report (one patient)
• Who was studied: one 60-year-old man with biopsy-confirmed stage IV non-small cell lung carcinoma who had watering of both eyes for the past year; seen at the LV Prasad Eye Institute, Hyderabad, India
• Exposure: cyclical pemetrexed chemotherapy (870 mg); no asbestos exposure is described
• Main results:
  • Epiphora began after the patient completed four cycles of chemotherapy, with no epiphora before the fourth cycle
  • Epiphora worsened with each later cycle, reaching grade 5 on the Munk epiphora scale
  • All four puncta showed gross stenosis (pinpoint openings), and dacryoendoscopy showed diffuse canalicular stenosis without any areas of obstruction
  • Balloon puncto-canaliculoplasty was done on all four puncta under local anesthesia, with the balloon inflated to eight atmospheres for 90 seconds
  • A mini-Monoka stent was placed for four weeks
  • Dilatation was achieved and maintained in all four puncta, and epiphora resolved (Munk scale 0 to 1)
  • There was no recurrence for up to 6 months after the operation
• The authors' conclusion: The authors concluded that this rare case of pemetrexed-induced punctal and canalicular stenosis was successfully managed by non-incisional, minimally invasive methods. They also stated that patients on pemetrexed should be monitored for epiphora and referred to ophthalmology when it first appears.

Topics

Medical terms in this study, explained in our Lexicon: Pemetrexed (Alimta), Mesothelioma, Carcinoma.

Related studies

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• Usp9x- and Noxa-mediated Mcl-1 downregulation contributes to pemetrexed-induced apoptosis in human non-small-cell lung cancer cells — J. Yan, N. Zhong, et al. (2014)
• Death receptor 5 and cellular FLICE-inhibitory protein regulate pemetrexed-induced apoptosis in human lung cancer cells — L. Su, G. Liu, et al. (2011)
• Pemetrexed induced acute kidney injury in patients with non-small cell lung cancer: reversible and chronic renal damage — G. Rombolà, F. Vaira, et al. (2015)
• Pemetrexed-induced scleroderma-like conditions in the lower legs of a patient with non-small cell lung carcinoma — K. Ishikawa, T. Sakai, et al. (2016)
• Fatal pemetrexed-induced lung injury in patients with advanced mesothelioma: a report of two cases — K. Nagata, R. Kaji, et al. (2010)

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