Mirvetuximab related corneal curvature fluctuations and consequent unstable refractive shift

Purpose : To describe the dynamic corneal changes following treatment with mirvetuximab soravtansine (MIRV) and to introduce characteristic imaging findings that help explain the refractive fluctuations observed during follow-up. Methods : A 56-year-old woman who underwent MIRV therapy presented with bilateral blurred vision. A comprehensive ophthalmologic evaluation, including slit-lamp examination, visual acuity testing, keratometry, corneal topography, and anterior segment optical coherence tomography, was performed. Findings were monitored during multiple follow-up visits. Results: Biomicroscopic examination revealed microcyst-like epithelial changes (MECs) in the mid-periphery. Corneal topography demonstrated irregular steepening corresponding to MEC distribution, while OCT imaging showed hyperreflective epithelial and stromal deposits. Over time, the deposits migrated toward the central and inferior corneas and then disappeared owing to the washout effect of the drug. The distribution and elimination processes produce unstable reshaping patterns and fluctuating refractive errors. At the last examination, visual acuity and aberration improved. No corneal haze or opacity was observed. Topical corticosteroid therapy did not provide a significant clinical benefit. Conclusion: MIRV-related corneal toxicity leads to unstable irregular astigmatism, increased higher-order aberrations, and fluctuating refractive status without corneal opacity. Recognizing this unique course is crucial for ophthalmologists to achieve accurate diagnosis, monitor visual outcomes, and provide appropriate patient counseling.