Accelerated Bilateral Cataract Progression during Olaparib plus Bevacizumab Maintenance Therapy for High-Grade Serous...

Primary peritoneal carcinoma and high-grade serous fallopian tube carcinoma share histopathologic and molecular characteristics with high-grade serous ovarian carcinoma and are treated according to similar therapeutic principles. Poly (ADP-ribose) polymerase (PARP) inhibitors, particularly olaparib, have become central to maintenance therapy, frequently administered with the anti-VEGF agent bevacizumab. Although olaparib is generally well tolerated, ocular toxicities such as cataract formation have not been documented in clinical trials or pharmacovigilance reports, and detailed descriptions are lacking.

We report a 66-year-old woman with FIGO stage IIIC high-grade serous carcinoma of the fallopian tube with BRCA mutation and homologous recombination deficiency. After neoadjuvant chemotherapy with paclitaxel, carboplatin, and bevacizumab, followed by interval debulking surgery and postoperative chemotherapy, she achieved a complete response and began maintenance therapy with bevacizumab plus olaparib. After three cycles, she developed rapidly progressive visual impairment in the right eye. Ophthalmologic evaluation revealed a hypermature (Morgagnian-type) cataract with partial liquefaction requiring phacoemulsification with intraocular lens implantation. At the initial ophthalmologic examination, a contralateral mature cataract was also identified but was asymptomatic. Approximately 1 month after right eye surgery, the left eye developed symptomatic visual decline, necessitating cataract extraction. Postoperative recovery of both eyes was excellent.

To our knowledge, this is the first report describing bilateral accelerated cataract progression during olaparib therapy, particularly in combination with bevacizumab. While causality cannot be confirmed, the rapid onset, bilateral involvement, and temporal association with therapy suggest a potential treatment-related effect. Possible mechanisms include cytokine dysregulation, oxidative stress, and exacerbation of subclinical lens pathology.

This case highlights a previously unreported ocular adverse event associated with combined PARP inhibitor and anti-VEGF maintenance therapy. Clinicians should maintain vigilance for visual symptoms and consider periodic ophthalmologic monitoring in patients receiving prolonged olaparib-based therapy.