Chemotherapy-induced cystoid macular edema in ovarian cancer

Abstract

Chemotherapy for malignant tumors causes various adverse events that require treatment. Ovarian cancer treatment employs several drugs, including paclitaxel, carboplatin, and bevacizumab. Here the authors report a rare case of cystoid macular edema induced by treatment with paclitaxel and bevacizumab for recurrent ovarian cancer, which significantly reduces patients' quality of life. Case Report The present patient was a 63-year-old female. Primary debulking surgery was performed two years previously, and she was diagnosed with ovarian clear cell carcinoma pT2cN1M0, FIGO Stage 3A1 [2] (complete surgery). Six courses of first-line chemotherapy with paclitaxel and carboplatin were postoperatively administered without any severe adverse events. Two recurrent lesions of the peritoneum were observed seven months after the first course of treatment; the patient was again treated with paclitaxel and carboplatin. However, the lesions progressed during the six additional courses of treatment; hence, the recurrence was re-diagnosed with platinum resistant. Weekly paclitaxel and tri-weekly bevacizumab; paclitaxel-bevacizumab treatment was initiated. For the first three weeks, the patient was treated as an inpatient, whereas from the second course onwards, the patient was treated as an outpatient. Exertional dyspnea, eyelid edema, lower thigh edema, and visual abnormality began to appear during the second course of the treatment. Cardiac function was assessed via ultrasound examination for those symptoms, and mildly reduced ejection fraction of the left ventricular (58%) was observed. Up to six courses of chemotherapy were administered with strict follow-up. No change in blood pressure was observed, and cardiac function improved, as revealed by the increase in the ejection fraction (67%). However, her visual abnormality did not improve; the authors consulted an ophthalmologist, and she was diagnosed with cystoid macular edema based on the results of optical coherence tomography and angiography (Figure 1). The recurrent lesion was stable for 21 weeks, during which seven