| OCR Text |
Show Poster 111 A Case of Suspected Paclitaxel-associated Maculopathy Denis Huang1, Neesurg Mehta1, Kit Tam1, Kareem Moussa1, Yin Allison Liu1 1 University of California, Davis, Sacramento, California, USA Introduction: Drug-induced cystoid macular edema (CME) is a rare ophthalmologic finding in patients taking paclitaxel, an antimicrotubule agent used to treat solid tumors. We report a case of presumed paclitaxel-related bilateral CME in a patient on palliative paclitaxel/gemcitabine chemotherapy for pancreatic adenocarcinoma. Description of Case(s): A 55-year-old Asian male with metastatic pancreatic adenocarcinoma on palliative paclitaxel-gemcitabine chemotherapy presented to the neuro-ophthalmology clinic with new onset central vision loss in the right eye and peripheral vison loss in both eyes. His past medical history was notable for a primary pituitary macroadenoma, which was resected 2 weeks prior to our evaluation. Initial exam showed best-corrected visual acuity of count fingers at 2 feet in the right eye and 20/80 in the left eye, a right relative afferent pupillary defect, and bilateral optic atrophy with a partial bitemporal hemianopia by Humphrey visual field testing consistent with compressive optic neuropathy from the pituitary tumor. At 6 months followup visit, he reported no vision changes. However, new bilateral CME was observed on optical coherence tomography with faint macular petaloid leakage in both eyes on fluorescein angiography. These findings are highly suggestive of druginduced CME secondary to paclitaxel. Previous reports of paclitaxel-related maculopathy were bilateral, associated with decreased vision and, notably, had angiographic-negative CME.1–3 Given the life-prolonging nature of his chemotherapy regimen, paclitaxel was continued. In consultation with our vitreoretinal service, he was subsequently started on topical prednisolone acetate 1% and ketorolac for treatment of CME. Conclusions, including unique features of the case(s): To our knowledge, we present the first case of presumed paclitaxel maculopathy in pancreatic cancer with positive fluorescein angiographic findings. In complex oncologic patients, as reflected in this case, vision may be affected by multiple etiologies. While stopping chemotherapy may lead to resolution of drug-induced CME,4 the decision to stop life-saving treatment is not to be taken lightly and requires a careful multi-disciplinary approach. References: 1. Bassi E, Loizzi V, Furino C, et al. Cystoid macular edema secondary to paclitaxel therapy for ovarian cancer: A case report. Mol Clin Oncol. 2017;7(2):285. doi:10.3892/MCO.2017.1296 2. Yokoe T, Fukada I, Kobayashi K, et al. Cystoid Macular Edema during Treatment with Paclitaxel and Bevacizumab in a Patient with Metastatic Breast Cancer: A Case Report and Literature Review. Case Rep Oncol. 2017;10(2):605. doi:10.1159/000477897 3. Burgos-Blasco B, HernandezRuiz S, Lopez-Guajardo L, Donate-Lopez J. Dexamethasone intravitreal implant in cystoid macular edema secondary to paclitaxel therapy. Am J Ophthalmol Case Reports. 2020;18:100653. doi:10.1016/J.AJOC.2020.100653 4. Joshi MM, Garretson BR. Paclitaxel Maculopathy. Arch Ophthalmol. 2007;125(5):709-710. doi:10.1001/ARCHOPHT.125.5.709. Keywords: chemotherapy and radiation injury, optic neuropathy, tumors, retina, diagnostic tests (ERG, VER, OCT, HRT, mfERG, etc) Financial Disclosures: The authors had no disclosures. Grant Support: Dr. Liu is supported in part by the UC Davis Paul Calabresi Career Development Award for Clinical Oncology as funded by the National Cancer Institute/National Institutes of Health through grant #2K12CA138464-11. Contact Information: Yin Allison Liu, MD, PhD, aycliu@ucdavis.edu 2022 Annual Meeting Syllabus | 175 |
