Korean J Ophthalmol.  2012 Oct;26(5):394-397. 10.3341/kjo.2012.26.5.394.

A Case of Paclitaxel-induced Maculopathy Treated with Methazolamide

• Koo NK
• Kim YC

• KMID: 1397493
• DOI: http://doi.org/10.3341/kjo.2012.26.5.394

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.

Keyword

Macular edema; Methazolamide; Paclitaxel

MeSH Terms

Antineoplastic Agents, Phytogenic/*adverse effects
Breast Neoplasms/drug therapy
Diuretics/*therapeutic use
Female
Humans
Macular Edema/*chemically induced/*drug therapy
Methazolamide/*therapeutic use
Middle Aged
Paclitaxel/*adverse effects
Visual Acuity

Figure

• 

  Fig. 1 Fundus angiographic image of the right eye. (A) Marked central cystic change of the macula. (B) No fluorescein leakage on the macula.

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  Fig. 2 Optical coherence tomographic images of both eyes. (A) Thick cystoid macular edema in the right eye before methazolamide treatment. (B) Improved cystoid macular edema in the right eye after methazolamide treatment for nine days. (C) Greatly improved cystoid macular edema in the right eye after methazolamide treatment for 23 days. (D) Slightly aggravated cystoid macular edema in the right eye after paclitaxel with methazolamide treatment. (E) Newly developed cystoid macular edema in the left eye during paclitaxel chemotherapy. (F) Complete resolution of the cystoid macular edema in the right eye after discontinuation of paclitaxel chemotherapy. (G) Complete resolution of the cystoid macular edema in the left eye after discontinuation of paclitaxel chemotherapy.

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