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. 2017 Sep 30:11:298-304.
doi: 10.2174/1874364101711010298. eCollection 2017.

Presumed Chemotherapy-Induced Optic Neuropathy and Maculopathy: A Case Report

David J Mathew  1 , Anupriya Arthur  1 , Sheeja Susan John  1
Affiliations

Presumed Chemotherapy-Induced Optic Neuropathy and Maculopathy: A Case Report

David J Mathew et al. Open Ophthalmol J. .

Abstract

Purpose: With the advent of more aggressive cytotoxic chemotherapy regimens, the incidence of ocular toxicity due to these drugs is also on the rise. We report a case of Presumed Chemotherapy-Induced optic neuropathy and maculopathy secondary to treatment with cytarabine and daunorubicin for Acute Myeloid Leukaemia (AML).

Case report: A 50-year-old man with AML developed sudden decrease in vision in his left eye after three cycles of chemotherapy with cytarabine and daunorubicin. He presented to us six weeks later with bilateral optic atrophy and foveal atrophic changes with early bull's eye maculopathy. A diagnosis of presumed chemotherapy-induced optic neuropathy with maculopathy was made, and the patient was put on an alternative chemotherapeutic regimen. There was no further decrease in vision on follow up.

Conclusion: To the best of our knowledge, this is the first report of clinically demonstrable macular toxicity in the form of macular atrophic changes and bull's eye maculopathy associated with the use of cytarabine and daunorubicin. Early diagnosis and appropriate management of such cases is imperative to prevent further visual deterioration.

Keywords: AML; Cancer chemotherapy; Cytarabine; Daunorubicin; Toxic maculopathy; Toxic optic neuropathy.

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Figures

Fig. (1)
Fig. (1)
Color fundus photograph showing optic disc pallor and foveal atrophic changes in a bull’s eye configuration in both eyes.
Fig. (2)
Fig. (2)
MRI scan of the orbit showing no evidence of active neuritis or infiltration of the optic nerves.
Fig. (3)
Fig. (3)
Automated perimetry showing peripheral depressed points in the right eye and constriction of the visual field in the left eye with a small temporal island of vision.
Fig. (4)
Fig. (4)
Optical coherence tomography (OCT) showing thinning of the retinal nerve fibre layer in both eyes, left eye being more affected than the right.
Fig. (5)
Fig. (5)
OCT of the macula showing thinning and alteration of the foveal contour.
Fig. (6)
Fig. (6)
Fundus fluorescein angiography showing window defects with mottled hyperfluorescence in the parafoveal region in both eyes.
See this image and copyright information in PMC

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