Occam Versus Hickam: Irreversible Vision Loss From Paclitaxel-Induced Cystoid Macular Edema

Area of Science:

• Ophthalmology
• Oncology
• Pharmacology

Background:

• Paclitaxel is a key chemotherapy agent for invasive breast cancer.
• Cystoid macular edema (CME) is a potential ocular side effect of chemotherapy.
• Macular telangiectasia is a rare retinal vascular disorder.

Observation:

• A patient developed CME shortly after initiating paclitaxel treatment.
• Multimodal imaging revealed changes consistent with macular telangiectasia.
• Visual acuity did not fully recover despite paclitaxel discontinuation.

Findings:

• This is the first reported case of irreversible vision loss from paclitaxel-induced CME without phototoxicity.
• Paclitaxel toxicity may exacerbate pre-existing macular telangiectasia.
• Ellipsoid zone loss was observed after CME resolution.

Implications:

• Ophthalmologists should monitor for ocular toxicity in patients receiving paclitaxel.
• Paclitaxel's role in exacerbating underlying retinal conditions warrants further investigation.
• This case underscores the risk of permanent vision impairment from chemotherapy side effects.