Reduction in peripapillary retinal thickness after Thalidomide Treatment in Patients with POEMS Syndrome

PurposeTo determine whether thalidomide treatment can reduce the optic disc edema in patients with the polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, and skin changes (POEMS) syndrome.MethodsThis was a retrospective, observational case series. We studied 14 eyes of 7 treatment naïve patients with POEMS syndrome. Thalidomide treatment was initiated with 100 mg daily and thalidomide dose was subsequently increased to 300 mg daily and 12 mg/m2 dexamethasone was combined on 4 days of monthly intervals. The peripapillary retinal thickness (pRT) thickness was determined by spectral‐domain optical coherence tomography (SD‐OCT) to assess the degree of optic disc edema. The pRT thickness were measured at the baseline and 6 months after the thalidomide treatment. The SD‐OCT examinations consisted of circle scans of 3.45 mm diameter centered on the optic disc. The serum level of VEGF was also determined by enzyme‐linked immunosorbent assays (ELISAs) at the baseline and 6 months after beginning the treatment. The Wilcoxon signed‐rank test was used to determine if the differences between the pRT at the baseline and 6 months after the treatment were significant. We also determined if the differences in the serum levels of VEGF at the baseline and 6 months after the treatment were significant.ResultsAt the baseline, the mean pRT was 674.7 ± 300.3 μm and the mean serum level of VEGF was 5902 ± 2237 pg/ml. At 6 months after the treatment, the mean serum level of VEGF was significantly decreased to 1491 ± 2062 pg/ml (p < 0.01) and the pRT was significantly decreased to 356.5 ± 108.2 μm (p < 0.01).ConclusionsOur results showed that thalidomide treatment reduced the peripapillary retinal thickness together with a decrease in the serum VEGF levels. These findings suggest that the optic disc edema might be due to elevated serum levels of VEGF.