Neurotrophic Keratitis Associated With Telisotuzumab Vedotin: A Case Report

PURPOSE: To describe the first reported case of neurotrophic keratitis (NK) associated with telisotuzumab vedotin (Teliso-V), a c-MET-targeted antibody-drug conjugate (ADC) approved for metastatic non-small cell lung cancer (NSCLC). CASE REPORT: A 56-year-old woman with metastatic NSCLC developed bilateral, painless blurred vision approximately 10 weeks after initiating Teliso-V therapy. Initial findings of punctate keratopathy progressed to bilateral persistent corneal epithelial defects despite treatment with topical corticosteroids, preservative-free artificial tears, bandage contact lenses, prophylactic antibiotics, and amniotic membrane transplantation. Corneal esthesiometry demonstrated markedly reduced corneal sensation bilaterally, consistent with NK. Concurrent Grade 1 peripheral neuropathy also developed. Teliso-V was discontinued because of ocular toxicity. Following initiation of topical cenegermin 0.002% six times daily, epithelial defects resolved within one week in the left eye and three weeks in the right eye, with recovery of best-corrected visual acuity to 20/20 in both eyes and partial improvement in corneal sensation. No recurrence was observed six weeks after completion of therapy. CONCLUSIONS AND IMPORTANCE: This report describes the first documented case of NK associated with Teliso-V therapy. The temporal association between Teliso-V exposure, bilateral corneal hypoesthesia, persistent epithelial defects, and concurrent peripheral neuropathy suggests a potential neurotoxic mechanism related to the drug's monomethyl auristatin E payload. Clinicians should maintain a high index of suspicion for NK in patients receiving ADCs who present with painless visual decline and corneal epithelial disease. Early diagnosis and prompt treatment with cenegermin may facilitate corneal healing and prevent vision-threatening complications.