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Intravitreal dexamethasone impant versus topical dorzolamide in nab-paclitaxel induced cystoid macular edema

Author: Mariachiara Di Pippo (Italy)

Co-authors: Federico Di Staso, Serena Fragiotta, Chiara Ciancimino, Solmaz Abdolrahimzadeh

Purpose

To assess the effect of intravitreal dexamethasone and topical dorzolamide on cystoid macular edema (CME) induced by systemic nab-paclitaxel treatment

Setting/Venue

Academic medical center - Retina Centre, Ophthalmology Unit, NESMOS Department, University of Rome Sapienza, St. Andrea Hospital, Rome

Methods

A patient with vision loss owing to bilateral CME induced by nab-paclitaxel was evaluated with visual acuity assessment, complete ophthalmological examination, and multimodal imaging. Systemic therapy with nab-paclitaxel could not be suspended following multidisciplinary consultation. Therapy with topical dorzolamide was initiated in the left eye as the patient referred treatment with intravitreal dexamethasone in another setting 1 week previously.

Results

Best-corrected visual acuity was 20/32 in the right and 20/40 in the left eye. Bilateral CME was confirmed with spectral domain optical coherence tomography (OCT). Fundus fluorescein angiography showed foveal petaloid CME with increased late-phase hyperfluorescence. Indocyanine green angiography, fundus autofluorescence, Enface OCT, and OCT angiography also showed CME. At 3 weeks of follow up visual acuity was 20/20 in both eyes. There was CME resolution both in the eye with the intravitreal dexamethasone implant and the fellow eye treated with topical dorzolamide.

Conlusions

The therapy for nab-paclitaxel related CME is currently much debated due to the unclear pathogenesis of the edema. To date the only therapy that has been shown to completely solve the CME is nab-paclitaxel cessation, Unfortunately, this is not always possible when systemic conditions of patients do not permit therapy discontinuation. The efficacy of intravitreal dexamethasone and topical dorzolamide in the resolution of edema and in the visual recovery, suggest that multiple mechanisms are involved in the pathogenesis of nab-paclitaxel induced CME.

Financial Disclosure

None

Comments

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