Taxane Maculopathy

This 55YO female presented with an 8-month history of bilateral vision loss. She had been treated for metastatic breast cancer with Taxol (paclitaxel) for 1 year prior to this exam. Vision was 20/200 OU.

Triton imaging and swept-source OCT show severe symmetrical bilateral cystoid changes in each macula. The cystoid changes are most pronounced in the outer nuclear layer and less so in the inner nuclear layer. Fluorescein angiography shows no leakage.

We have consulted with her oncologist, and expect him to discontinue the paclitaxel. The macular changes and vision should improve within several months.

Learning Points:
Paclitaxel is a member of the taxane family of microtubule-stabilizing agents that is used to treat various solid malignant tumors. Their major adverse effects are bone marrow toxicity and peripheral neuropathy. Ophthalmic complications are rare, including taxane-related cystoid macular edema (CME).

Unlike more common exudative causes for CME, there is no angiographic leakage, and OCT shows intact and continuous inner and outer plexiform layers (see Perez et al, Graefe’s 2020;258:1607-1615).

The cause for CME is uncertain but may be due to Müller cell dysfunction (see Nakao et al, Ophthalmic Surg Lasers Retina 2016;47:81-84). There is no treatment for the CME other than stopping the causative drug.