Abstract: Objective To explore the clinical characteristics of drug-related ocular adverse reactions caused by antibody-drug conjugates (ADC) in tumor treatment. Design Retrospective case series. Participants  7 patients (14 eyes) with ocular adverse reactions to ADC who were treated at the Chinese Academy of Medical Sciences Peking Union Medical College Hospital from March 2024 to December 2024. Methods Clinical patients who received ADC-based tumor treatment and had ocular adverse reactions were included. Comprehensive ophthalmic examinations were conducted, and the types and grades of drug-related ocular adverse reactions were recorded and analyzed. Main Outcome Measures Incidence of symptoms, incidence of signs, incidence of visual acuity decline, and incidence of different lesion grades. Results There were 6 male patients and 1 female patient, with an average age of 55.6±3.2 years. All patients had bilateral involvement. The related adverse reaction symptoms included: eye redness (85.8%), foreign body sensation (57.1%), blurred vision (57.1%), tearing (42.9%), and eye itching (14.3%); The related adverse reaction signs included: ocular congestion (85.8%), conjunctival edema (71.4%), increased secretions (57.1%), eyelid-scleral adhesion (42.9%), pseudomembrane (42.9%), follicular hyperplasia (42.9%), rough corneal epithelium (42.9%), corneal epithelial defect (28.6%), corneal opacity (14.3%), and corneal neovascularization (14.3%); During the lesion process, the most severe situation of visual acuity decline was: visual acuity decline of 1 line (42.9%), visual acuity decline of 2 lines (21.4%), visual acuity decline of 3 lines (14.3%), and visual acuity decline of 5 lines or more (21.4%); The proportion of grade 2, grade 3, and grade 4 drug-related ocular adverse reactions was 42.9%, 28.6%, and 28.6%, respectively. After anti-inflammatory and symptomatic treatment, the ocular lesion conditions of all patients were ultimately stabilized. Conclusions The use of ADC for tumor treatment has the potential risk of causing severe ocular adverse reactions. It is necessary to pay sufficient attention, conduct close follow-up, and actively treat.

Key words: Antibody-drug conjugate, Adverse drug reaction, Ocular toxicity, Conjunctivitis, Keratitis