Paclitaxel-induced maculopathy: review of treatment management

Author: Irene Garcia del Moral (Spain)

Co-authors: Juan Francisco Martinez Jerez

Purpose

To present a case of bilateral maculopathy secondary to paclitaxel treatment in a patient with breast cancer.

Setting/Venue

Ophthalmology Department University Hospital San Agustín, Linares-Jaén (Spain).

Methods

Retrospective observational case report and review of different treatment options.

Results

A 80-year-old female patient with breast cancer presented at our Emergency Unit complaining about bilateral vision loss and scintillating scotomas. Best corrected visual acuity (BCVA) was 0.4 in both eyes. Dilated fundus examination and optical coherence tomography showed bilateral cystoid macular edema (CME) and drusen. The fluorescein angiography showed pooling in macular region without any leakage. There were no signs of ocular inflammation. Other causes related to this type of CME were ruled out. The patient was under treatment with paclitaxel prior breast cancer surgery, and discontinuation of this drug was not an option. Treatment with oral acetazolamide and ketorolac eye drops twice a day was initiated. Complete resolution of cystoid macular edema was achieved four months after onset of symptoms, with BCVA improved to 0.9 in both eyes.

Conlusions

Cystoid macular edema is a known but rare complication of the taxane class drugs, such as paclitaxel and docetaxel. Both drugs are mitotic inhibitors. The pathophysiology of taxane-related CME remains unclear. Müller cells toxicity has been proposed as a possible mechanism for non leaking CME, with subsequent intracellular fluid accumulation. Many treatment options have been described in literature: cessation of taxan drugs, topical and oral carbonic anhydrase inhibitors (such as dorzolamide, methazolamide, acetazolamide), pentoxifylline, topical steroidal and non steroidal agents, sub-Tenon triamcinolone acetonide injection and intravitreal triamcinolone and bevacizumab injections.

Financial Disclosure

No financial disclosure to declare.