Macular Cystoid Edema Induced by Nab-Paclitaxel

Abstract

A 61-year old male was referred to the Ophthalmology department because of decreased bilateral visual acuity. The patient had metastatic pancreatic adenocarcinoma and was being treated with gemcitabine+nab-paclitaxel. On examination, the patient presented best corrected visual acuities of 4/20 and 2/20 in the right and left eye, respectively. The optical coherence tomography revealed bilateral severe macular edema. Macular edema was considered secondary to nab-paclitaxel and the drug was discontinued. Three months after drug discontinuation, the patient presented best corrected visual acuities of 20/20 and 16/20 in the right and left eye, respectively, and normal fundoscopy. Macular edema is a very rare side effect of taxanes, and the etiopathology is still unknown. Edema is usually reversible upon discontinuation of the offending agent. Clinicians should be aware of this adverse effect of taxanes, and a high index of clinical suspicion is essential for diagnosis.

Systemic family therapists and dementia: A constructivist grounded theory study

“…Numerous authors have promoted the value of family therapy in a dementia context while also acknowledging that research on many aspects of this subject was either missing or inadequate to generate a robust evidence base (Benbow et al, 1993(Benbow et al, , 2014Curtis & Dixon, 2005;Edwards et al, 2018;Goncalves-Pereira & Sampaio, 2011;Jeffery, 2019;Koethe et al, 2014;Roper-Hall, 2008). In a dementia context, SFTs have been reported to help with supporting adaptation to role changes (Bonjean, 1989;Wolinsky, 1985), relationship difficulties (Villemaire et al, 1987), consideration of wider influences (Vernooij-Dassen et al, 2010), stress reduction (Johannsen & Fischer-Johannsen, 2011), crisis situations and difficult care decisions (Cantegreil-Kallen & Rigaud, 2009), adapting to diagnosis, marital adjustment, depression and providing wider systemic benefits (Zahn, 2015).…”

“…For example, an SFTs could position themselves as curious and unknowing when learning about a family's culture, preferences and ways of making sense of the world; while also holding Mason's (2019) authoritative-doubt position, in which therapist knowledge and expertise are acknowledged, when talking about dementia, organisational processes and associated resources. Therapeutic opportunities risk being missed through assuming that families have had adequate exposure to information (Benbow et al, 2019;Goncalves-Pereira, 2017;Goncalves-Pereira & Sampaio, 2011;Long, 1997). Collaborative decisions could be made about if and where to incorporate psycho-education into therapy; however, engaging in such 'informed orienteering' requires SFTs to know their subject (Benbow et al, 2019;Jacobs, 2016;Long, 1997;Shotter, 2008).…”