Cystoid Macular Edema with Docetaxel Chemotherapy and the Fluid Retention Syndrome

Telander, David G.; Sarraf, David

doi:10.1080/08820530701457373

Cited by 71 publications

(39 citation statements)

References 5 publications

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“…CMO without fluorescein leakage is a rare occurrence. Only a few conditions are associated with angiographically silent CMO, and these include some types of retinitis pigmentosa, juvenile X-linked retinoschisis, Goldmann-Favre syndrome and niacin toxicity [10]. The pathogenesis of angiographically silent TDICMO is still unclear but resembles niacin-induced CMO.…”

Section: Discussionmentioning

confidence: 98%

The mystery of angiographically silent macular oedema due to taxanes

Kuznetcova

Čech²,

Herbort

2012

Int Ophthalmol

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Taxanes are widely used anticancer agents, produced from the plants of the genus Taxus (yews). One of the rare side-effects caused by taxanes is a bilateral cystoid macular oedema (CMO). The particularity of this type of CMO is that it is angiographically silent showing no leakage or pooling on fluorescein angiography (FA). To date, the mechanism of this oedema has not been clearly understood and existing theories do not explain this phenomenon very well. Our aim was to report a case of paclitaxel-induced CMO and put forward a putative explanation for this occurrence. A 64-year-old woman presented with a 7-month history of progressively decreasing bilateral visual acuity with an apparently normal fundus. At entry her best-corrected visual acuity (BCVA) was 0.4 for far and near OD and 0.5 for far and near OS. Optical coherence tomography (OCT) revealed a CMO with a central thickness of 561 μm OD and 488 μm OS; there were no signs of intraocular inflammation. FA showed no capillary leakage and quasi absent late hyperfluorescence OU. Indocyanine green angiography was within normal limits. Classical CMO treatment was ineffective and only discontinuation of paclitaxel resulted in recovery of a normal macular structure after 4 weeks with an increase of BCVA to 0.9 OD and 1.0 OS. In order to understand the properties of taxane drug-induced cystoid macular oedema (TDICMO) we compared the spectral OCT findings of our case to an inflammation-induced CMO of equal thickness and to a case of multifocal choroiditis. The plane of separation of TDICMO was above the external limiting membrane in both cases. In contrast to inflammation-induced CMO where the four external bands were well identified, there was attenuation of these bands in TDICMO but no disruption of the layers as seen in multifocal choroiditis, indicating that the fluid in TDICMO had a high viscosity producing a shadow underneath. TDICMO most probably originates from retinal pigment epithelium dysfunction by their effect on microtubule functions and not from vascular leakage. The content of the CMO seems to be made up of viscous fluid. As the origin of the CMO is not inflammatory, classical CMO treatments have no effect and only discontinuation of the taxane drug allows reversal of the CMO.

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Section: Discussionmentioning

confidence: 98%

The mystery of angiographically silent macular oedema due to taxanes

Kuznetcova

Čech²,

Herbort

2012

Int Ophthalmol

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“…The particularity of the taxane-associated CME is that it is angiographically silent, a feature that was classically seen in nicotinic acid maculopathy and some types of retinitis pigmentosa, juvenile X-linked retinoschisis and Goldmann-Favre syndrome [14,38]. The pathophysiology behind this kind of CME remains unclear.…”

Section: Discussionmentioning

confidence: 99%

“…CME was angiographically silent and partially reversible after the cessation of treatment. A few other cases have since been reported with docetaxel [14,15], paclitaxel, and nab-paclitaxel [16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31]. Amongst these reports, 2 have shown regression of CME in spite of continuing the taxane-based chemotherapy, by giving oral acetazolamide alone [20] or in conjunction with topical nonsteroidal anti-inflammatory drugs (ketorolac) [24], but not with concomitant intravenous bevacizumab [21].…”

Section: Introductionmentioning

confidence: 99%

Central Macular Thickness Monitoring after a Taxane-Based Therapy in Visually Asymptomatic Patients

et al. 2017

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Background: Taxanes are drugs used in various chemotherapeutical protocols to treat solid tumors. They have multiple systemic adverse effects, such as bone marrow suppression, alopecia, nausea, and vomiting, and may rarely cause ocular symptoms. In the past decade, a few reported cases have shown the occurrence of a cystoid macular edema with significant visual loss after the use of a taxane-based chemotherapy. The aim of this study was to compare the central macular thickness (CMT) before and after the initiation of a taxane-based therapy in visually asymptomatic patients and to elucidate the possible impact of these drugs on the vision of cancer patients. Methods: Patients with a confirmed diagnosis of a solid tumor were screened for any ophthalmic disease before inclusion and had a baseline macular spectral domain optical coherence tomography (OCT; RTVue-100; Optovue Inc., Fremont, CA, USA) before the initiation of a taxane-based chemotherapy according to different protocols, such as 4EC-4T, 3FEC/3T, or 4TC. OCT was repeated after 4 cycles (or 3 months) of treatment, and CMT was compared to baseline. Patients presenting diabetic retinopathy, age-related macular degeneration or any condition that causes macular edema confirmed by ophthalmic examination were excluded. Results: Fifty eyes of 25 patients were included; 92% of the subjects were female with a mean age of 48.52 years, 88% were diagnosed with breast cancer, 8% with esophageal cancer, and 4% with ovarian cancer. Docetaxel was the taxane administered to 92% of the patients. The received dose of docetaxel ranged between 110 and 160 mg. The other patients had paclitaxel in their protocols. No significant macular edema or drop in visual acuity were noted in any patient. Nevertheless, the mean CMT was found to be increased, particularly in the parafoveal and perifoveal areas (mean difference of +2.22 μm; p = 0.001). Conclusion: Taxane-based chemotherapy regimens seem to increase macular thickness, with a relative sparing of the fovea, in patients without significant macular edema. Further research is required to better explain the pathophysiology and possible impact of this phenomenon.

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“…This leads to fluid accumulation in the intracellular space. It has been well established that taxane agents cause fluid retention, represented by edema, weight gain, and third-space fluid collection (pericardial, pleural, ascites), and this appears to be associated with their cumulative dose (7,8). Considering the cases where there was no indication of systemic fluid retention, Koo and Kim (9) have suggested that CME was presumed to occur as a result of cellular toxicity derived from the suppression of intracellular microtubule reorganization (9).…”

Section: Discussionmentioning

confidence: 99%

Cystoid macular edema secondary to paclitaxel therapy for ovarian cancer: A case report

Bassi

Loizzi

Furino

et al. 2017

Molecular and Clinical Oncology

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Abstract. Paclitaxel is a member of the taxane agents that has demonstrated efficacy in ovarian cancer, both in first-and in second-line therapy. Counted among the side-effects of this drug are neurological disorders. In the present study, a rare case of a non-neuropathic ocular disorder, known as cystoid macular edema (CME), due to paclitaxel in patients treated for ovarian cancer is described. Macular edema, or CME, is a common cause of visual impairment that has been classically demonstrated by fluorescein angiograms, showing capillary leakage. CME without fluorescein leakage is rare, and its most common causes are juvenile X-linked retinoschisis, Goldmann-Favre syndrome, and niacin toxicity. At the present time, the mechanism associated with the form of CME that does not exhibit any signs of fluorescein leakage has not been elucidated due to an absence of histopathological studies. Several mechanisms have been proposed, although it is considered to occur due to disruption of the normal blood-retinal barrier by molecules with a molecular weight lower than that of fluorescein, which leads to fluid accumulation in the intracellular space. It is well known that taxane agents cause fluid retention, represented by edema, weight gain, and third-space fluid collection (pericardial, pleural, ascites), and this appears to be associated with their cumulative dose. The present case study confirms that macular edema associated with paclitaxel use exhibits spontaneous resolution following discontinuation of the causative agent. Taxane-associated maculopathy has been scarcely reported in the literature, but the gynecological oncologist should be alert to its possible development, and an ophthalmologic evaluation should be offered to all patients using paclitaxel. IntroductionPaclitaxel is a member of the taxane agents that has demonstrated efficacy in ovarian cancer, both in first-and in second-line therapy (1). Neurological disorders are counted among the side-effects of this drug (2). In the present study, a rare case of a non-neuropathic ocular disorder known as cystoid macular edema (CME), due to the use of paclitaxel in patients treated for ovarian cancer, is described. Case reportIn September 2007, a 49-year-old woman underwent optimal debulking surgery for FIGO stage IIIC ovarian serious cancer, with residual disease following surgery (a tumor measuring <1 cm). The patient received adjuvant chemotherapy based on carboplatin and paclitaxel for six cycles every three weeks, achieving a complete response. The cumulative dose of paclitaxel was 1,680 mg. After 13 months, the patient presented with hepatic metastasis and peritoneal nodules. In view of the recurrence of the disease, the patient received chemotherapy based on carboplatin and pegylated liposomal doxorubicin. After 8 cycles of the chemotherapy, based on the disease progression the patient subsequently received Topotecan for 13 cycles. However, the patient then presented with pulmonary progression disease, and consequently she was treated with paclitaxel (60 m...

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Cystoid Macular Edema with Docetaxel Chemotherapy and the Fluid Retention Syndrome

Cited by 71 publications

References 5 publications

The mystery of angiographically silent macular oedema due to taxanes

The mystery of angiographically silent macular oedema due to taxanes

Central Macular Thickness Monitoring after a Taxane-Based Therapy in Visually Asymptomatic Patients

Cystoid macular edema secondary to paclitaxel therapy for ovarian cancer: A case report

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