A Case of Paclitaxel-induced Maculopathy Treated with Methazolamide

Abstract

A 54-year-old female patient who had been undergoing anti-cancer chemotherapy and radiotherapy for seven years after surgery for left breast cancer visited our clinic for visual disturbance in the right eye at nine months after paclitaxel administration. The best-corrected visual acuity was 0.5 in the right eye and 1.0 in the left eye. The patient was diagnosed with maculopathy due to paclitaxel administration based on the finding of cystoid macular edema in the right eye on fundus examination and optical coherence tomography; however, no leakage was detected on fluorescein angiography. Thus, drug replacement was planned. On the other hand, no abnormal finding was observed in the left eye. However, as the anti-cancer effect of paclitaxel is significant, replacing paclitaxel with another agent was not warranted; therefore, maintenance therapy with methazolamide was performed before and after administering the anti-cancer agent. Aggravation of cystoid macular edema was prevented, and vision improvement was achieved by oral maintenance therapy with methazolamide. In addition, the same fundus findings as shown in the right eye were detected in the left eye at 16 months after paclitaxel administration. After administering methazolamide, macular thickness was reduced, and vision was improved in the left eye. Paclitaxel administration was discontinued due to cutaneous metastasis from the breast cancer, and another anti-cancer agent was then administered. No subsequent cystoid macular edema has occurred.

Single-eye trial of a topical carbonic anhydrase inhibitor versus intravitreal bevacizumab for the treatment of taxane drug-induced cystoid macula oedema

“…Alternatively, microtubule disruption may render the blood-retinal barrier more permeable to small molecules like H 2 O, without affecting barrier function to larger molecules like fluorescein 5. Both of these postulated mechanisms can explain macular oedema without leakage on FFA.…”

“…Patients unable to cease the taxane usually have persistent CMO,10 although some case reports have shown resolution or stabilisation of CMO with the addition of a systemic CAI 5 19. Visual acuity usually, but not always, returns to baseline.…”

Paclitaxel‐induced cystoid macular oedema

“…Several authors proposed that direct toxicity of taxane on M€ uller cells may deteriorate ion regulation and cause cellular swelling and cystic formation (Teitelbaum & Tresley 2003;Georgakopoulos et al 2012;Koo & Kim 2012). Poor response to anti-inflammatory treatments might exclude the possibility of inflammatory cause.…”

“…Bilateral CME without fluorescein leakage is a rare complication of these medications. Including our patient, 24 cases of taxane-induced CME were identified in English literature (Teitelbaum & Tresley 2003;Telander & Sarraf 2007;Murphy et al 2010;Georgakopoulos et al 2012;Koo & Kim 2012). The onset of CME could start from two months to three and a half years after taxane treatment.…”

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

“…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].…”