Bilateral Serous Maculopathy Associated with Acalabrutinib Therapy in Chronic Lymphocytic Leukemia

PURPOSE: To describe a case of bilateral central serous chorioretinopathy (CSC)-like maculopathy associated with Bruton's tyrosine kinase inhibitor acalabrutinib therapy in a patient with chronic lymphocytic leukemia (CLL). METHODS: Single-patient case report with retrospective review of clinical findings and multimodal imaging, including ultrawidefield (UWF) pseudocolor photography, fundus autofluorescence, fluorescein angiography, spectral-domain optical coherence tomography, and UWF swept-source OCT. RESULTS: A 68-year-old man presented with marked vision loss, count fingers at 1 foot in right eye (OD), and 20/150 in the left eye (OS). He had chronic lymphocytic leukemia treated with acalabrutinib and obinutuzumab. Examination and multimodal imaging showed a large fovea-involving serous macular detachment OD and a large serous pigment epithelial detachment (PED) with overlying subretinal fluid (SRF) OS, with no hemorrhage and no evidence of macular neovascularization or optic disc leakage on fluorescein angiography. A single intravitreal aflibercept injection was administered OD, and acalabrutinib was discontinued. Within 2-4 weeks, optical coherence tomography demonstrated near-complete resolution of SRF OD and collapse of the PED with a dry macula OS while other systemic therapy remained unchanged; after acalabrutinib was restarted, serous PEDs with associated SRF recurred in both eyes. CONCLUSIONS: The bilateral, reversible serous maculopathy tightly linked to acalabrutinib exposure supports a drug-related etiology. BTK inhibitors should be considered in cases of new bilateral serous SRF/PEDs, and prompt coordination with oncology may facilitate recovery through systemic therapy modification.