Taxane-associated retinopathy and radiation-induced optic neuropathy in a young female patient with metastatic breast cancer

Abstract

Introduction: Metastatic breast cancer leads to significant challenges in terms of treatment and management, often requiring a multidisciplinary approach due to the potential side effects of chemotherapy and radiotherapy.

Case description: We present a case of a metastatic breast cancer patient with central serous chorioretinopathy, recurrent cystoid macular edema, and radiation-induced optic neuropathy that occurred after the treatment with paclitaxel and radiation. A 42-year-old female patient presented to our department with a one-week history of painless, subacute vision loss in her left eye, occurring one year after completing oncological treatment. Her best corrected visual acuity (BCVA) was 20/32 in her left eye, and the optical coherence tomography (OCT) showed central serous chorioretinopathy with spontaneous resolution within 1 month. Seven months later, she presented with a sudden decrease in vision in her right eye; the BCVA was 20/40, the relative afferent pupillary defect was found, and the visual field demonstrated a superior altitudinal defect corresponding to the inferior segmental optic nerve pallor, prompting us to start treatment with prednisolone. Six months later, her vision had fallen to light perception in the right eye and 20/25 in the left eye. The OCT findings were conclusive for cystoid macular edema in her left eye, so we started treatment with aflibercept. Unfortunately, we could not improve the visual outcome in the right eye, which had an amaurotic pupil. Regarding the left eye, the patient experienced recurrent macular edema treated with aflibercept. After several episodes, the patient's BCVA decreased to 20/50 without any improvement.

Conclusion: Herein we stated a young patient with metastatic breast cancer who developed a rare and unusual overlap of side effects: paclitaxel-associated retinopathy and radiation-induced optic neuropathy. We aim to illustrate the challenge of managing advanced breast cancer patients and emphasize the importance of careful monitoring for ocular complications, which can impact the patient's quality of life.

Keywords: breast cancer; central serous chorioretinopathy; hydroxychloroquine; macular edema; paclitaxel; radiation-induced optic neuropathy.

Figure 1. a) Central serous chorioretinopathy after paclitaxel; b) resolution of CSCR after one month

Figure 2. a) Altitudinal visual field defect of the right eye; b) optic disc pallor and RNFL thinning (temporal and inferior)

Figure 3. a) Macular edema before aflibercept injection; b) resorption of macular edema after aflibercept injection (one month later)