2024年 · 第104卷第38期

A 67-year-old female was seen in the Department of Ophthalmology of Beijing Tongren Hospital affiliated to Capital Medical University on April 15, 2021 due to "binocular vision loss for more than 3 months". Four years after total hysterectomy for endometrial cancer, tumor recurrence and metastasis occurred for more than one year. Other hospitals received systemic chemotherapy and abdominal radiotherapy. Of these, 21 systemic chemotherapy sessions were used with paclitaxel. Eye examination: the best corrected visual acuity was 0.2 for the right eye and 0.3 for the left eye; Foveal reflex disappeared in both eyes on fundus examination (Figure 1); Ocular optical coherence tomography (OCT) showed cystoid macular edema in both eyes (FIG. 2); Fundus fluorescence angiography (FFA) showed normal fundus optic disc fluorescence and no fluorescein leakage from retinal capillaries (Figure 3). The clinical diagnosis was paclitaxel-associated retinopathy, and the use of paclitaxel chemotherapy was discontinued after consultation with the oncology department. Two years later, the patient complained of improvement in binocular vision at a follow-up visit. Eye examination: the best corrected visual acuity was 0.4 for the right eye and 0.7 for the left eye; Both fundus and OCT examination showed regression of edema in the macular area. Paclitaxel is a mitotic inhibitor that can interfere with microtubule rupture, and can be clinically used for the treatment of malignant tumors such as breast metastatic cancer, ovarian cancer and Kaposi's sarcoma. The typical clinical manifestation of paclitaxel-associated retinopathy is decreased visual acuity after treatment with paclitaxel; The fundus was characterized by cystoid macular edema, and FFA showed no fluorescein leakage from retinal vessels; The macular edema resolved after drug discontinuation. Discontinuation is the preferred treatment strategy when systemic conditions allow. At present, there are a few reports of topical application of carbonic anhydrase inhibitors and steroid hormones to improve macular edema, but its efficacy is still uncertain. This patient met the clinical characteristics of paclitaxel-related retinopathy, so the diagnosis was made.