Chin Ju Juen, Wan Hitam Wan-Hazabbah, Chong Mei Fong, Lee Saw Joo, Yew Jing Mun, Ngoo Qi Zhe
Ophthalmology and Visual Sciences, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, MYS.
Ophthalmology, Hospital Universiti Sains Malaysia, Kubang Kerian, MYS.
Cureus. 2023 Aug 22;15(8):e43943. doi: 10.7759/cureus.43943. eCollection 2023 Aug.
Background Carboplatin and paclitaxel are two standard chemotherapeutic agents known to cause neurotoxicity. In this study, we aim to evaluate the toxicity of these agents by measuring the peripapillary retinal nerve fiber layer (RNFL) and macular thickness in patients with endometrial and ovarian cancers who are receiving them. Methods A one-year prospective cohort study involving 28 patients who were treated intravenously with carboplatin (200-400 mg/m) and paclitaxel (175 mg/m) three-weekly for six cycles was conducted. RNFL and macula thickness were measured using optical coherence tomography (OCT) before the commencement of chemotherapy, after the third cycle, and one month after the sixth cycle. The main outcome measurements were the average RNFL thickness and central subfield thickness of the macula. Results The mean age of the 28 participants was 54.68 years old (standard deviation [SD] 9.03). Eleven had endometrial cancer, while 17 had ovarian cancer. The mean of the average RNFL thickness during baseline pre-chemotherapy was 96.43 µm (SD 11.39). One month after cessation of treatment, the mean RNFL thickness increased to 101.57 µm (SD 13.54). Statistical analysis showed a significant increment in the mean RNFL thickness (p≤ 0.001), from baseline to after three cycles, and baseline to one month after six cycles of chemotherapy, except the nasal quadrant. The increment of all macular quadrants was statistically significant (p < 0.05) except for central subfield thickness. Conclusion Systemic administration of carboplatin and paclitaxel affected both the peripapillary RNFL and macula thickness. This represents early evidence of subacute subclinical retinal toxicity. OCT can be used as a screening tool to assess peri-chemotherapeutic retinal alterations.
背景 卡铂和紫杉醇是两种已知会引起神经毒性的标准化疗药物。在本研究中，我们旨在通过测量接受这些药物治疗的子宫内膜癌和卵巢癌患者的视乳头周围视网膜神经纤维层（RNFL）和黄斑厚度来评估这些药物的毒性。方法 进行了一项为期一年的前瞻性队列研究，纳入28例患者，他们接受卡铂（200 - 400mg/m）和紫杉醇（175mg/m）静脉注射，每三周一次，共六个周期。在化疗开始前、第三个周期后以及第六个周期后一个月，使用光学相干断层扫描（OCT）测量RNFL和黄斑厚度。主要观察指标为黄斑的平均RNFL厚度和中心子区域厚度。结果 28名参与者的平均年龄为54.68岁（标准差[SD]9.03）。11例患有子宫内膜癌，17例患有卵巢癌。化疗前基线时平均RNFL厚度为96.43µm（SD 11.39）。治疗停止后一个月，平均RNFL厚度增加至101.57µm（SD 13.54）。统计分析显示，除鼻侧象限外，从基线到三个周期后以及从基线到六个周期化疗后一个月，平均RNFL厚度有显著增加（p≤0.001）。除中心子区域厚度外，所有黄斑象限的增加均具有统计学意义（p<0.05）。结论 卡铂和紫杉醇的全身给药对视乳头周围RNFL和黄斑厚度均有影响。这代表了亚急性亚临床视网膜毒性的早期证据。OCT可作为一种筛查工具来评估化疗期间的视网膜改变。
