Recurrent cystoid macular oedema associated with high-dose cytarabine therapy

To describe a rare case of recurrent, reversible cystoid macular oedema (CME) associated with high-dose cytarabine therapy in a patient with acute myeloid leukaemia (AML).

A 39-year-old woman with AML developed recurrent bilateral visual disturbances following multiple cycles of high-dose cytarabine monotherapy. After each chemotherapy cycle, spectral-domain optical coherence tomography revealed cystoid intraretinal spaces predominantly involving the outer nuclear and outer plexiform layers. Fluorescein angiography demonstrated faint perifoveal leakage without the classic petaloid pooling pattern of CME. Macular oedema resolved spontaneously after the initial treatment cycles but showed progressively delayed regression after subsequent exposures. No systemic or ocular risk factors for CME were identified, and there was no evidence of inflammatory, vascular, or infectious retinal disease.

High-dose cytarabine may rarely cause recurrent and reversible CME as a manifestation of posterior segment toxicity. The underlying mechanism is likely related to transient Müller cell dysfunction or retinal pigment epithelium impairment rather than disruption of the blood-retinal barrier. Awareness of this entity is essential to ensure prompt recognition and appropriate management, including consideration of treatment modification when clinically feasible.