Intravitreal Ranibizumab Had Limited Effect on Cystoid Macular Edema Due to Albumin-Bound Paclitaxel: A Case Report and Literature Review

Abstract

Angiographically silent cystoid macular edema (CME) is a rare complication from nab-paclitaxel. Here we report a 45-year-old woman with breast cancer who developed CME after several months of treatment with albumin-bound paclitaxel (nab-paclitaxel). Her visual acuity did not improve significantly with the cessation of nab-paclitaxel and intravitreal ranibizumab treatment. Then, brinzolamide eye drops were prescribed. One month later, her vision improved, with the macular edema significantly subsided. Finally, we reviewed other cases of CME induced by nab-paclitaxel that have been reported in the literature and discussed the underlying pathogenesis of nab-paclitaxel-induced CME.

Docetaxel-Induced Bilateral Cystoid Macular Edema with a Low Cumulative Dose: A Case Report

“…SD-OCT images show larger hyporeflective cysts located in the outer nuclear layer and smaller cysts in the inner nuclear layer, with an intact outer retinal layer. The involvement is focal and symmetrical, centered around the fovea [8][9][10][11][12][13][14][15]. These same SD-OCT results were found in our patient.…”

“…These same SD-OCT results were found in our patient. The absence of hyperreflective plaques associated with exudation seen in central retinal vein occlusion and diabetes edema, does not establish the outcome of vascular degeneration or vascular occlusion [10].…”

“…She reports no flow disturbance in a normal foveal avascular area supporting the hypothesis that this is not a vascular-mediated phenomenon. Acetazolamide, prednisolone, triamcinolone, dorzolamide and intravitreal injection of anti-Vascular endothelial growth factor (anti-VGEF) [10][11][12][13][14][15], have been used in the treatment of these T-CME, however, none of these products has proven effective. In most reported cases, resorption of macular edema occurs spontaneously after discontinuation of taxanes without any ocular treatment within 1.5 weeks to 6 months) [10][11][12][13][14][15].…”

“…In their recent literature review, Ya-Ting Ye & al [7], the average time to onset of macular edema after taking the drug was 4.25 months. However, in another review, it is 9.3 months with a range: from 1.5 to 42 months[10].…”