Paclitaxel may be a risk factor for retinal phototoxicity

Jonathan Malcolm; Caroline Oi Lune Wong; Jared Ching; Shohista Saidkasimova

doi:10.1016/j.ajoc.2022.101292

Paclitaxel may be a risk factor for retinal phototoxicity

Am J Ophthalmol Case Rep. 2022 Jan 20:25:101292. doi: 10.1016/j.ajoc.2022.101292. eCollection 2022 Mar.

Authors

Jonathan Malcolm¹, Caroline Oi Lune Wong², Jared Ching^{3

4}, Shohista Saidkasimova³

Affiliations

¹ Lancaster Medical School, Lancaster University, Lancaster, UK.
² Southend University Hospital, Southend-on-Sea, Essex, UK.
³ Department of Ophthalmology, Norfolk and Norwich University Hospital, Norwich, UK.
⁴ John Van Geest Centre for Brain Repair, University of Cambridge, UK.

Abstract

Purpose: To report the first case, to our knowledge, of suspected paclitaxel induced phototoxic maculopathy following vitrectomy surgery.

Observations: A 62-year-old phakic female receiving paclitaxel therapy for ovarian carcinoma presented with a best corrected visual acuity (BCVA) of 20/40 OD with an epiretinal membrane (ERM) and lamellar macular hole on spectral domain optical coherence tomography (SD-OCT). The patient underwent an uneventful pars plana vitrectomy with ERM peel using standard illumination and vitrectomy settings. Membrane Blue Dual (DORC, Netherlands) was used to stain the ERM. Two weeks post-operatively, the patient presented with a reduced BCVA of 20/200 in the operated eye. Fluorescein and indocyanine green angiography revealed right sided patchy hypofluorescence and hyperfluorescence secondary to retinal pigment epithelium changes with intact choroidal and retinal vasculature. SD-OCT and fundoscopy showed right sided loss of ellipsoid layer, increased reflectivity within the retinal pigmented epithelium and subretinal fibrosis without cystoid macular edema. Four months post-operatively her vision had stabilized to 20/160; unfortunately, the patient was palliated a month later due to ovarian carcinoma progression.

Conclusions: A number of drugs are known to increase photosensitivity to solar and artificial forms of radiation. Paclitaxel use has been widely reported to cause dermatological photosensitivity. We report a case of suspected paclitaxel induced phototoxic maculopathy following endoillumination during vitrectomy surgery.

Keywords: Paclitaxel; Photosensitizer; Phototoxicity; Retina; Vitrectomy.

Publication types

Case Reports