Lurbinectedin improves macular edema in a case of central retinal vein occlusion

Abstract

Purpose: To evaluate the response to lurbinectedin in a case of macular edema, secondary to central retinal vein occlusion (CRVO). Serial spectral domain optical coherence tomography (SD-OCT) scans were taken in a 70-year-old man with a 24-month history of macular edema secondary to CRVO in the right eye. The patient underwent 5 cycles of chemotherapy with lurbinectedin between October 2018 and May 2019. Central macular thickness (CMT) before and after each chemotherapy cycle was measured together with progression analysis using the CIRRUS Zeiss software.

Observations: SD-OCT showed alternating recurrence and resolution of macular edema closely related to the chemotherapy administrations. CMT oscillated between 496 and 284 μm during the follow-up. The macular edema was showed to decrease as soon as 4 days following chemotherapy.

Conclusions and importance: Resolution of macular edema associated with CRVO was seen in our patient whilst undergoing chemotherapy with lurbinectedin. Lurbinectedin may play a role in the treatment of macular edema secondary to CRVO and may open new therapeutic indication for this natural marine molecule.

Keywords: 1-central retinal vein occlusion; Keyword 2-lurbinectedin; Keyword 3- macular edema; Keyword 4; Keyword 5; Natural anticancer drugs; Optical coherence tomography.

Fig. 1

Fundus color photo at presentation (July 2018) showing vascular tortuosity without intraretinal hemorrhages in the right eye (RE), and absence of retinal changes in the left eye. Note the hemorrhage on the nasal aspect of the optic nerve. (For interpretation of the references to color in this figure legend, the reader is referred to the Web version of this article.)

Fig. 2

On the left, spectral domain optical coherence tomography (SD-OCT) right eye showing increased intraretinal thickness caused by slight edema secondary to central retinal vein occlusion (July 2018). On the right, SD-OCT showing resolution of the edema in the right eye (August 2018).

Fig. 3

Spectral domain optical coherence tomography showing alternating recurrence and resolution of macular edema (ME) strictly related to the chemotherapy sessions. Note also the presence of drusen. 3a – ME before treatment with lurbinectedin (October 2018), with central macular thickness (CMT) of 413 μm 3b – resolution of ME 11 days post treatment with lurbinectedin, CMT of 300 μm 3c - recurrence of ME before treatment with lurbinectedin (January 2019), CMT of 496 μm 3d – resolution of ME 4 days following treatment with lurbinectedin, CMT reduced to 284 μm 3e – recurrence of ME before further treatment with lurbinectedin, CMT increased to 449 μm.

Fig. 4

Spectral domain optical coherence tomography progression analysis. Red lines: Chemotherapy sessions with lurbinectedin (16.10.2018, 18.1.2019, 8.2.2019, 25.3.2019, 27.5.2019); Green line: the central subfield thickness (average retinal thickness in a disc-shaped region of 1 mm diameter centered on the fovea); Yellow line: the average cube thickness (macular thickness map using a macular cube 512 × 128). Note the decrease of the ME following the chemotherapy sessions. (For interpretation of the references to color in this figure legend, the reader is referred to the Web version of this article.)