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Shihadeh S, Patrick MM, Postma G, Trokthi B, Maitland C. Blinding Optic Neuropathy Associated With Carboplatin Therapy: A Case Report and Literature Review. Cureus 2024; 16:e52975. [PMID: 38406141 PMCID: PMC10893981 DOI: 10.7759/cureus.52975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 01/25/2024] [Indexed: 02/27/2024] Open
Abstract
Various forms of cancer and chemotherapeutics are associated with optic neuropathy. Cisplatin is a platinum analogue chemotherapeutic commonly associated with ocular toxicity among many other serious adverse effects. Carboplatin is a more chemically stable platinum analogue that is generally better tolerated with a comparatively favorable side effect profile. There are very few reports of carboplatin precipitating optic neuropathy. This case report describes a rare occurrence of carboplatin-induced blinding optic neuropathy. We treated a patient receiving carboplatin for neuroendocrine bladder cancer who developed rapidly progressive bilateral optic neuropathy over the course of three days. Upon evaluation at our clinic, his visual acuity had declined to light perception only and 20/60 in his left and right eye, respectively. Carboplatin therapy was immediately held and steroids were initiated. Despite the intervention, the patient's visual deficits have not improved at the one-year follow-up. Although the mechanism by which carboplatin causes ocular toxicity remains speculative, arterial ischemia appears to be the likely mechanism given the irreversible nature of visual decline. As demonstrated by our patient's course, irreversible vision loss despite high-dose steroid intervention necessitates expeditious recognition and management of this rare adverse effect. .
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Affiliation(s)
- Sammy Shihadeh
- Clinical Sciences, Florida State University College of Medicine, Tallahassee, USA
| | - Madison M Patrick
- Clinical Sciences, Florida State University College of Medicine, Tallahassee, USA
| | - Galen Postma
- Clinical Research, Florida State University College of Medicine, Tallahassee, USA
| | - Brenda Trokthi
- Clinical Research, Florida State University College of Medicine, Tallahassee, USA
| | - Charles Maitland
- Clinical Sciences, Florida State University College of Medicine, Tallahassee, USA
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Maleki A, K. Lagrew M, D. Slaney E, MD. Bilateral Optic Neuropathy Secondary to Intravenous Carboplatin Therapy. J Ophthalmic Vis Res 2024; 19:133-136. [PMID: 38638619 PMCID: PMC11022029 DOI: 10.18502/jovr.v19i1.15448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 02/26/2023] [Indexed: 04/20/2024] Open
Abstract
Purpose To report a case of carboplatin-induced bilateral optic neuropathy in a patient with metastatic squamous cell carcinoma of the tongue. Case Report A 65-year-old man with a history of squamous cell carcinoma of the tongue with metastasis to the right axillary lymph node treated with carboplatin and paclitaxel was evaluated for decreased visual acuity in both eyes. Visual acuity was 20/70 in the right eye and no light perception in the left eye. On dilated fundus examination, optic disc edema was present in both eyes with more severity in the left eye, flame shape hemorrhages around the optic nerve head in both eyes and cotton wool spots around the left optic nerve head. Brain and orbital MRI demonstrated enhancement of the bilateral optic nerve sheaths. He was diagnosed with bilateral carboplatin-induced optic neuropathy. Conclusion Our findings in this case justify monitoring of patients during their course of intravenous carboplatin therapy.
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Affiliation(s)
- Arash Maleki
- Department of Ophthalmology, University of Florida, Gainesville, FL, USA
- The Ocular Immunology and Uveitis Foundation, Waltham, MA, USA
| | - Mollie K. Lagrew
- Department of Ophthalmology, University of Florida, Gainesville, FL, USA
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Chin JJ, Wan Hitam WH, Chong MF, Lee SJ, Yew JM, Ngoo QZ. Evaluation of Retinal Nerve Fiber Layer and Macular Thickness Pre- and Post-Chemotherapy With Carboplatin and Paclitaxel in Patients With Endometrial and Ovarian Cancer. Cureus 2023; 15:e43943. [PMID: 37746413 PMCID: PMC10513924 DOI: 10.7759/cureus.43943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/22/2023] [Indexed: 09/26/2023] Open
Abstract
Background Carboplatin and paclitaxel are two standard chemotherapeutic agents known to cause neurotoxicity. In this study, we aim to evaluate the toxicity of these agents by measuring the peripapillary retinal nerve fiber layer (RNFL) and macular thickness in patients with endometrial and ovarian cancers who are receiving them. Methods A one-year prospective cohort study involving 28 patients who were treated intravenously with carboplatin (200-400 mg/m2) and paclitaxel (175 mg/m2) three-weekly for six cycles was conducted. RNFL and macula thickness were measured using optical coherence tomography (OCT) before the commencement of chemotherapy, after the third cycle, and one month after the sixth cycle. The main outcome measurements were the average RNFL thickness and central subfield thickness of the macula. Results The mean age of the 28 participants was 54.68 years old (standard deviation [SD] 9.03). Eleven had endometrial cancer, while 17 had ovarian cancer. The mean of the average RNFL thickness during baseline pre-chemotherapy was 96.43 µm (SD 11.39). One month after cessation of treatment, the mean RNFL thickness increased to 101.57 µm (SD 13.54). Statistical analysis showed a significant increment in the mean RNFL thickness (p ≤ 0.001), from baseline to after three cycles, and baseline to one month after six cycles of chemotherapy, except the nasal quadrant. The increment of all macular quadrants was statistically significant (p < 0.05) except for central subfield thickness. Conclusion Systemic administration of carboplatin and paclitaxel affected both the peripapillary RNFL and macula thickness. This represents early evidence of subacute subclinical retinal toxicity. OCT can be used as a screening tool to assess peri-chemotherapeutic retinal alterations.
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Affiliation(s)
- Ju Juen Chin
- Ophthalmology and Visual Sciences, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, MYS
- Ophthalmology, Hospital Universiti Sains Malaysia, Kubang Kerian, MYS
- Ophthalmology, Hospital Raja Permaisuri Bainun, Ipoh, MYS
| | - Wan-Hazabbah Wan Hitam
- Ophthalmology and Visual Sciences, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, MYS
| | - Mei Fong Chong
- Ophthalmology, Hospital Raja Permaisuri Bainun, Ipoh, MYS
| | - Saw Joo Lee
- Gynae-Oncology, Hospital Raja Permaisuri Bainun, Ipoh, MYS
| | - Jing Mun Yew
- Biostatistics and Research Methodology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, MYS
| | - Qi Zhe Ngoo
- Ophthalmology and Visual Sciences, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, MYS
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Sakellakis M, Spathas N, Tsaousis KT, Nikitiadis EN, Linardou H, Diakonis VF. Potential Ophthalmological Side Effects Induced by Anti-Neoplastic Regimens for the Treatment of Genitourinary Cancers: A Review. Cureus 2022; 14:e27266. [PMID: 36039252 PMCID: PMC9403378 DOI: 10.7759/cureus.27266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/25/2022] [Indexed: 12/02/2022] Open
Abstract
The outcomes of patients with genitourinary (GU) cancers have been steadily improving in recent years. Novel therapies have entered our armamentarium, while several other regimens are currently being studied in clinical trials. This recent explosion of new agents has improved patient survival and the quality of life for patients, but has also significantly increased the frequency of several side effects. The current review will focus on the potential ocular adverse reactions of GU neoplastic treatments. The broad spectrum of manifestations of ocular toxicity underscores the uniqueness and complexity of the anatomic, physiologic, and metabolic features of the human eye. Most side effects are mild in severity and transient, but some can be severe, disabling, and irreversible. Clinicians should be aware of complications that might be vision threatening and impact the patient's quality of life. In this review, we focused on the ocular toxicity of the antineoplastic regimens that are currently used for the treatment of GU, including prostate cancer, bladder cancer, renal cell carcinoma, testicular cancer, pheochromocytoma, adrenocortical carcinoma, and penile cancer.
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Lin SH, Xu YG, Zhao JH, Cui H, Jin H, Jia YJ, Zhao J, Li YJ. Choroidal metastasis with retinal detachment: A case report. Medicine (Baltimore) 2021; 100:e28009. [PMID: 34941041 PMCID: PMC8702016 DOI: 10.1097/md.0000000000028009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 11/11/2021] [Indexed: 01/05/2023] Open
Abstract
RATIONALE Breast carcinoma is the most common primary source of choroidal metastasis (CM). In the present case, esophageal cancer was the primary tumour, brain metastasis occurred, and CM occurred later in the left eye with 2 retinal detachments, which is very rare. PATIENT CONCERNS A 62-year-old man complained of a sudden decrease in visual acuity consisting of a small shadow in front of his left eye with a sensation of covered vision after 1 cycle of systemic chemotherapy and radiotherapy for resected esophageal cancer with brain metastasis. Fundus examination revealed exudative retinal detachment without retinal tears. CM with exudative retinal detachment was also considered. The patient refused further treatment. After the second cycle of chemotherapy, there were no significant changes in the retina and visual acuity improved. However, after craniocerebral surgery for brain metastasis, the visual acuity decreased again and showed 3 choroidal masses with macular involvement and retinal detachment but without retinal tears. DIAGNOSIS The final diagnosis was CM with retinal detachment. INTERVENTIONS The patient was advised to undergo enucleation of the left eye during the second retinal detachment, but he refused. OUTCOMES Two months after the second retinal detachment, the patient died of systemic metastases. LESSONS It is important to consider CM when the first retinal detachment and known cancer are diagnosed. At present, it is necessary to develop a standardised treatment plan as well as a multidisciplinary approach to early diagnosis, combined treatment, and timely intervention for such cases.
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Affiliation(s)
- Shu-Hua Lin
- Department of Ophthalmology, Affiliated Hospital of Yanbian University, Yanji Jilin, China
| | - Yong-Gen Xu
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China
| | - Jing-Hua Zhao
- Department of Ophthalmology, Affiliated Hospital of Yanbian University, Yanji Jilin, China
| | - Hong Cui
- Department of Ophthalmology, Affiliated Hospital of Yanbian University, Yanji Jilin, China
| | - Hua Jin
- Department of Ophthalmology, Affiliated Hospital of Yanbian University, Yanji Jilin, China
| | - Yu-Jie Jia
- Department of Ophthalmology, Affiliated Hospital of Yanbian University, Yanji Jilin, China
| | - Jian Zhao
- Department of Ophthalmology, Affiliated Hospital of Yanbian University, Yanji Jilin, China
| | - Ying-Jun Li
- Department of Ophthalmology, Affiliated Hospital of Yanbian University, Yanji Jilin, China
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Sekhon A, Wang JYF, Tan JCH, Holland SP, Yeung SN. Limbal stem cell deficiency secondary to systemic paclitaxel (Taxol) for breast cancer: a case report. BMC Ophthalmol 2020; 20:400. [PMID: 33028255 PMCID: PMC7542760 DOI: 10.1186/s12886-020-01672-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Accepted: 10/01/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Paclitaxel (PTX) is an antineoplastic drug widely used in treatments for ovarian, breast, and small-cell lung cancer. Although ocular effects associated with PTX have been previously described, very few studies have specifically reported systemic PTX as a contributing factor for limbal stem cell deficiency (LSCD), which is characterized by the loss of stem cell and barrier function of the limbus leading to progressive pain and reduction in visual acuity. Described here is a unique case where a patient was diagnosed with LSCD secondary to PTX use for the treatment of breast cancer, at doses of PTX far lower than what is reported in current literature. CASE PRESENTATION A 73-year-old woman with a previous diagnosis of breast cancer with liver metastasis presented with a complaint of increasing pain in the left eye more than the right, along with decreasing visual acuity in both eyes following 3 months of PTX therapy for recurrent liver metastases. Upon examination, best-corrected visual acuity was 20/100 in the right eye and counting fingers on the left. Peripheral neovascularization, stromal scarring, and features of limbal stem cell deficiency (LSCD) were noted on the right cornea. A central neurotrophic ulcer with thinning to 50% and 360 degrees of conjunctivalization were noted on the left. After the discontinuation PTX with doxorubicin as the substitute, there was no further progression of her LSCD, and stabilization of her ocular surface was achieved. CONCLUSION Although chemotherapy induced LSCD is a relatively rare adverse event, it is essential for clinicians starting new chemotherapy agents to consider the potential ocular toxicities that may result in their use. Ophthalmology review is recommended for patients after starting PTX therapy to assess for signs of LSCD, particularly in patients where drug toxicity can be aggravated due to impaired hepatic function.
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Affiliation(s)
- Amardeep Sekhon
- Department of Anesthesiology, Pharmacology and Therapeutics, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Jeff Y F Wang
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Johnson C H Tan
- Division of Cornea and External disease, Department of Ophthalmology and Visual Sciences, University of British Columbia, Vancouver, Canada.,National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore
| | - Simon P Holland
- Division of Cornea and External disease, Department of Ophthalmology and Visual Sciences, University of British Columbia, Vancouver, Canada.,Pacific Laser Eye Centre, Vancouver, Canada
| | - Sonia N Yeung
- Division of Cornea and External disease, Department of Ophthalmology and Visual Sciences, University of British Columbia, Vancouver, Canada. .,Eye Care Centre, Vancouver Hospital, 2550 Willow Street, Vancouver, BC, V5Z 3N9, Canada.
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Subepithelial Corneal Deposits Associated with Exemestane. Case Rep Ophthalmol Med 2020; 2020:5703164. [PMID: 32685225 PMCID: PMC7336228 DOI: 10.1155/2020/5703164] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 05/27/2020] [Accepted: 06/16/2020] [Indexed: 12/20/2022] Open
Abstract
This is a case report of corneal deposits noted in a 69-year-old female patient taking the aromatase inhibitor, exemestane, after undergoing a mastectomy and chemotherapy for breast cancer. The patient presented to our eye clinic for a new-onset floater in one eye, and bilateral subepithelial opacities were found incidentally on exam. The patient completed a 5-year course of the medication shortly after her initial visit with us and was noted to have a slight improvement in the density of the opacities on a follow-up visit 3 months later. We believe these corneal changes were most likely secondary to exemestane. The effect of aromatase inhibitors on the eye deserves further exploration as an increasing number of patients are prescribed these medications.
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Tang QL, Liu J, Zuo L, Chi C, Dong HY, Jiang XX, Jiang XF. Bilateral blindness with secondary retinitis pigmentosa following postoperative docetaxel and platinum combination chemotherapy in primary small-cell carcinoma of the endometrium: An unusual case report and review of the literature. Mol Clin Oncol 2017; 6:477-482. [PMID: 28413652 PMCID: PMC5374963 DOI: 10.3892/mco.2017.1174] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Accepted: 01/10/2017] [Indexed: 11/09/2022] Open
Abstract
Ocular toxicity is an uncommon complication of cytotoxic chemotherapy. Bilateral blindness with secondary retinitis pigmentosa (RP) following docetaxel and platinum combination chemotherapy at the recommended dose is extremely rare. The present study reports a case of advanced small-cell carcinoma (SCC) of the endometrium in a patient with diabetes mellitus type 2. The patient suffered from RP with a sharp decline in vision after the fourth course of postoperative docetaxel and platinum combination chemotherapy. Unfortunately, the patient developed bilateral blindness after another course of chemotherapy at a reduced dose. No tumor recurrence was observed during the 33 months of follow-up. A total of 35 cases of docetaxel- and/or platinum-induced retinal toxicity were found in the English literature and reviewed. The ischemic and electrophysiological hypotheses may have been implicated in the pathogenesis of ocular toxicity in the present case, particularly with the history of diabetes. Understanding the ocular side effects of this combination chemotherapy may assist gynecological oncologists and ophthalmologists with early recognition and timely intervention before blindness is established.
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Affiliation(s)
- Qiong-Lan Tang
- Department of Pathology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong 510120, P.R. China
| | - Jia Liu
- Department of Obstetrics and Gynecology, The First Affiliated Hospital, Jinan University, Guangzhou, Guangdong 510630, P.R. China
| | - Li Zuo
- Department of Obstetrics and Gynecology, The First Affiliated Hospital, Jinan University, Guangzhou, Guangdong 510630, P.R. China
| | - Cong Chi
- Department of Obstetrics and Gynecology, The First Affiliated Hospital, Jinan University, Guangzhou, Guangdong 510630, P.R. China
| | - Hui-Yu Dong
- Department of Obstetrics and Gynecology, The First Affiliated Hospital, Jinan University, Guangzhou, Guangdong 510630, P.R. China
| | - Xiao-Xia Jiang
- Department of Obstetrics and Gynecology, The First Affiliated Hospital, Jinan University, Guangzhou, Guangdong 510630, P.R. China
| | - Xue-Feng Jiang
- Department of Obstetrics and Gynecology, The First Affiliated Hospital, Jinan University, Guangzhou, Guangdong 510630, P.R. China
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Wang L, Miao H, Li X. Tamoxifen retinopathy: a case report. SPRINGERPLUS 2015; 4:501. [PMID: 26405621 PMCID: PMC4573752 DOI: 10.1186/s40064-015-1258-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 08/18/2015] [Indexed: 12/14/2022]
Abstract
Purpose To present a case of tamoxifen retinopathy on a 57-year-old woman. Design An observational case. Methods A review of history, clinical
examination, and findings on Spectral-domain Optical Coherence Tomography (SD-OCT), fluorescein angiogram (FA) and electro-oculogram (EOG) was conducted. Results A 57-year old female patient, who had been treated with oral tamoxifen after mastectomy due to breast cancer, had profound visual impairment in both eyes. Disruption of the ellipsoid zone and interdigitation zone which represent photoreceptor damage as well as macular thinning was revealed on SD-OCT in both eyes. Bilateral retinal pigmented epithelium (RPE) function compromised was indicated by reduced Arden ratio in EOG. Conclusion Tamoxifen-induced retinopathy could be detected by SD-OCT and EOG. As it is irreversible, patients who are given tamoxifen need regular ophthalmic consultation, including SD-OCT and EOG before and during the treatment in order to early detect and avoid further retinal damage.
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Affiliation(s)
- Lingling Wang
- Department of Ophthalmology, Peking University People's Hospital, Xizhimen South Street 11, 100044 Beijing, China ; Key Laboratory of Vision Loss and Restoration, Ministry of Education, Beijing, China ; Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, Beijing, China
| | - Heng Miao
- Department of Ophthalmology, Peking University People's Hospital, Xizhimen South Street 11, 100044 Beijing, China ; Key Laboratory of Vision Loss and Restoration, Ministry of Education, Beijing, China ; Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, Beijing, China
| | - Xiaoxin Li
- Department of Ophthalmology, Peking University People's Hospital, Xizhimen South Street 11, 100044 Beijing, China ; Key Laboratory of Vision Loss and Restoration, Ministry of Education, Beijing, China ; Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, Beijing, China
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