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Taxane Induced Cystoid Macular Edema: Case Report and Integrated Pathogenic Theory.

M Kanakis1, I Georgalas2, T Makatsoris3

  • 1University of Patras, Medical School, University Eye Clinic, Rion University Hospital, Patras, Greece.

Current Drug Safety
|August 30, 2018
PubMed
Summary

Paclitaxel, a chemotherapy drug, can cause silent cystoid macular edema (CME) in patients. Discontinuing paclitaxel treatment led to the complete recovery of vision and retinal function in a prostate cancer patient.

Keywords:
Cystoid macular edemaangiographically silent macular edemaaquaporinsintegrated pathogenic theorypaclitaxeltaxanes.

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Area of Science:

  • Ophthalmology
  • Oncology
  • Pharmacology

Background:

  • Paclitaxel is a chemotherapy agent used for various cancers, including prostate cancer.
  • Ocular side effects of chemotherapy can significantly impact patient quality of life.
  • Macular edema, a swelling in the retina, can lead to decreased visual acuity.

Observation:

  • A 73-year-old man developed decreased visual acuity due to bilateral macular edema after paclitaxel treatment for prostate cancer.
  • Ophthalmic evaluation revealed silent cystoid macular edema (CME) via Optical Coherence Tomography and Fluorescein Angiography.
  • The patient's visual acuity and retinal morphology improved completely within two months after paclitaxel cessation.

Findings:

  • Taxane-induced CME is proposed to result from impaired aquaporin-mediated water transport in retinal capillaries and the retinal pigment epithelium.
  • Paclitaxel's action on microtubule-guided aquaporin vesicle transport to the cell membrane is implicated in the pathogenesis of silent CME.
  • Cessation of paclitaxel therapy was sufficient for complete recovery, indicating a direct link between the drug and the ocular condition.

Implications:

  • This case highlights the importance of recognizing and managing paclitaxel-induced silent CME in cancer patients.
  • Understanding the mechanism of Taxane-induced CME can inform strategies for visual preservation during chemotherapy.
  • Ophthalmologists and oncologists should collaborate to monitor and address visual disturbances in patients receiving taxane-based therapies.