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揭开紫杉醇诱导的黄斑囊样水肿之谜:病例报告与文献综述

Unraveling the Mystery of Taxol-Induced Cystoid Macular Oedema: Case Report and Literature Review.

作者信息

Babovic Radomir, Burton Ben, Alex Nimesha, Harihar Lakshmi, Dugandzija Tihomir

机构信息

Ophthalmology Department, James Paget Hospital, Great Yarmouth, University of East Anglia, Norwich, United Kingdom.

Oncology Department, Norfolk and Norwich University Hospital, Norwich, United Kingdom.

出版信息

Rom J Ophthalmol. 2025 Jan-Mar;69(1):3-9. doi: 10.22336/rjo.2025.02.

Abstract

OBJECTIVES

The primary aim of this article is to present cystoid macular oedema as one of the side effects of Paclitaxel (Taxol) chemotherapy. Paclitaxel is used as a treatment option in patients with different types of solid carcinomas. The potential loss of vision, already altered by the disease, further compromises their quality of life, a contributing factor to overall psychological and mental decline.

CASE PRESENTATION

A 69-year-old woman developed a drop in visual acuity that was painless, bilateral, and accompanied by wavy lines. This occurred six months after starting Paclitaxel chemotherapy for metastatic breast cancer. The diagnosis of cystoid macular oedema caused by Paclitaxel was made. The visual acuity significantly improved after Paclitaxel was discontinued, and the symptoms subsided.

DISCUSSION

Paclitaxel is a chemotherapy drug used to treat various types of cancers and has been associated with cystoid macular oedema (CMO) in rare cases. CMO is thought to result from the disruption of the normal blood-retinal barrier. The specific mechanism remains incompletely understood, and multiple mechanisms have been postulated. In typical CMO, leakage from parafoveal capillaries is demonstrated on fluorescein angiograms in a classic petaloid pattern. However, in Taxane-Drug Induced CMO (TDICMO), there is no evidence of fluorescein leakage on angiography. TDICMO is a rare drug side effect of breast cancer treatment, described just 14 times in the English literature.

CONCLUSION

It is crucial to reiterate that if a patient undergoing Paclitaxel treatment experiences any vision changes, it is imperative to consult an ophthalmologist for a thorough evaluation and appropriate management. This step is essential for the patient's well-being and to ensure the best possible outcome.

摘要

目的

本文的主要目的是将黄斑囊样水肿作为紫杉醇(泰素)化疗的副作用之一进行阐述。紫杉醇被用作不同类型实体癌患者的一种治疗选择。已经因疾病而改变的视力潜在丧失,进一步损害了他们的生活质量,这是导致整体心理和精神衰退的一个因素。

病例介绍

一名69岁女性出现了无痛性、双侧视力下降,并伴有波浪线。这发生在开始针对转移性乳腺癌进行紫杉醇化疗6个月后。诊断为紫杉醇引起的黄斑囊样水肿。停用紫杉醇后视力显著改善,症状消退。

讨论

紫杉醇是一种用于治疗多种类型癌症的化疗药物,在罕见情况下与黄斑囊样水肿(CMO)有关。CMO被认为是由正常血视网膜屏障的破坏所致。具体机制仍未完全了解,已提出多种机制。在典型的CMO中,荧光素血管造影显示黄斑旁毛细血管渗漏呈典型花瓣状。然而,在紫杉烷类药物诱导的CMO(TDICMO)中,血管造影没有荧光素渗漏的证据。TDICMO是乳腺癌治疗中一种罕见的药物副作用,在英文文献中仅被描述过14次。

结论

必须重申,如果接受紫杉醇治疗的患者出现任何视力变化,务必咨询眼科医生进行全面评估和适当处理。这一步骤对患者的健康至关重要,并确保获得最佳可能结果。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/388d/12049643/d3faf8af0819/RomJOphthalmol-69-003-g001.jpg

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