Case Report: Intravitreal dexamethasone implant as adjuvant treatment for taxane-related cystoid macular edema

Abstract

Taxane-related cystoid macular edema (CME) is a rare complication of the taxoid medication, a chemotherapeutic drug. We report a 47-year-old Han Chinese man referred to our Eye Center for decreased vision with visual distortion in both eyes for two weeks. Two weeks prior, he received the last cycle of his six-monthly chemotherapy, including paclitaxel for hypopharyngeal malignancy. The best-corrected visual acuity (BCVA) was 0.4 OD and 0.1 OS. Macular optical coherence tomography showed significant bilateral CME, and fluorescein angiography (FA) revealed the fluorescein pooling at the late phase without leakage. Intravitreal 700 μg dexamethasone (DEX) implant was applied to the left eye and 13 days after to the right eye. Two months later, the macular morphology recovered to normal. One year after the first visit, the BCVA was 1.0 OD and 0.8 OS with standard macula on OCT. In conclusion, the intravitreal DEX implant might be an effective adjuvant treatment for taxane-related CME.

Keywords: cystoid macula edema; fluorescein angiography; intravitreal dexamethasone implant; optical coherence tomography; paclitaxel; taxanes.

Figure 1

Optical coherence tomography and fluorescein angiography at baseline Fundus photography of the right eye (A) and left eye (B) at baseline showed the honeycomb-like CME pattern. Optical coherence tomography scan of the right eye (C) and left eye (D) at baseline revealed a substantial elevation of Henle's fiber layer and cystoid-like edema scattered within the inner retinal layer. Fluorescein angiography at baseline revealed the fluorescein-stained fluid superior to the right eye fovea (E) and inferior to the left eye (F) starting at the retinal venous phase, resulting in the late pooling of a characteristic flower petal pattern and no leakage had been shown.

Figure 2

Clinical timeline for a 47-year-old Chinese male patient with taxane-related cystoid macular edema.

Figure 3

The trend of ILM-RPE thickness The ILM-RPE thickness of the ETDRS grid for the right eye (A) and the left eye (B).

Figure 4

Optical coherence tomography after treatment The macular optical coherence tomography (OCT) scans showed macular morphology of the right eye and left eye on Jun 18^th (A, B), July 6^th (C, D), July 15^th (E, F), and Aug 7^th (G, H).