Department of Medical Oncology, Cancer Center, West China Hospital, Sichuan University, 37 Guoxue Alley, Chengdu, 610041, People's Republic of China.
Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, 610041, China.
BMC Ophthalmol. 2019 Nov 21;19(1):236. doi: 10.1186/s12886-019-1246-3.
Visual impairment occurred as an infrequent form of chemotherapeutic toxicity and was often underestimated despite of several reports. We described a case of acute unilateral visual impairment after one cycle of intravenous chemotherapy of a normal dose, aiming at raising attention to chemotherapy-induced ocular toxicity.
The patient developed a progressive vision loss in the right eye during the chemotherapy. After one cycle of intravenous chemotherapy, her visual acuity decreased by 0.6 in the right eye (VOD = 0.4) compared to the previous value of 1.0 (VOD = 1.0). No evidence of ocular infiltration was observed from the cerebral magnetic resonance imaging (MRI). During her follow-up period, we documented the ophthalmologic examinations including visual acuity, visual field (VF), visual evoked potential (VEP), electroretinogram (ERG), fundus photograph (FP), fundus fluorescein angiography (FFA) and optical coherence tomography (OCT). Ophthalmoscope examination and fundus photograph showed optic disc edema, fuzzy boundary and linear hemorrhages in her right eye. Fundus fluorescein angiography (FFA) revealed capillary underdevelopment at the nasal and superior temporal area of the optic disc in the early phase and capillary fluorescein leakage in the late phase. The result of VEP test suggested the impaired function of the optic nerve. Thus, a diagnosis of nonarteritic anterior ischemic optic neuropathy (NAION) was made by the ophthalmologist according to these results. The patient was prescribed prednisone combined with neuroprotective drugs, which did not work. After the cessation of chemotherapy, her impaired vision gradually recovered.
This is the first reported case of acute visual impairment in a patient who underwent chemotherapy of a normal dose. It is indicated that while receiving benefits from chemotherapy, cancer patients simultaneously suffer from the risk of vision loss.
尽管已有多篇报道，但视力障碍作为一种罕见的化疗毒性形式仍常被低估。我们描述了一例在接受一周期常规剂量静脉化疗后出现单侧急性视力障碍的病例，旨在引起对化疗引起的眼毒性的关注。
该患者在化疗过程中右眼视力逐渐下降。一周期静脉化疗后，右眼视力较前次下降 0.6（VOD=0.4），而前次视力为 1.0（VOD=1.0）。脑部磁共振成像（MRI）未发现眼部浸润证据。在随访期间，我们记录了包括视力、视野（VF）、视觉诱发电位（VEP）、视网膜电图（ERG）、眼底照相（FP）、眼底荧光血管造影（FFA）和光学相干断层扫描（OCT）在内的眼科检查。眼底镜检查和眼底照相显示右眼视盘水肿，边界模糊，线性出血。眼底荧光血管造影（FFA）早期显示视盘鼻侧和颞上区毛细血管发育不良，晚期毛细血管荧光素渗漏。VEP 检查结果提示视神经功能受损。因此，眼科医生根据这些结果诊断为非动脉炎性前部缺血性视神经病变（NAION）。患者接受泼尼松联合神经保护药物治疗，但无效。停止化疗后，她受损的视力逐渐恢复。
这是首例报道的接受常规剂量化疗的患者发生急性视力障碍的病例。这表明，癌症患者在从化疗中获益的同时，也面临着视力丧失的风险。
