Abstract A 56 year old retired theatre nurse who has metastatic breast carcinoma complains of reduced vision in the left eye since being started on Docetaxel (Taxotere), an oral anti-mitotic chemotherapeutic agent. Best corrected visual acuity was 6/18 in the left eye, and 6/9-1 in the right. Clinical examination and subsequent examination with optical coherence tomography and Intravenous Fluorescein angiography revealed evidence suggestive of drug related maculopathy. No abnormal findings were present in the right eye. As far as we are aware, this is the first reported case of maculopathy following commencement of Docetaxel with the absence of macular oedema. Keywords Taxotere ; Docetaxel ; Breast cancer ; Maculopathy prs.rt("abs_end"); 1. Clinical practice points – Docetaxel is of the chemotherapy drug class taxane. – Mainstay of use is for breast cancer, prostate cancer, and non-small cell lung cancer. – Main dose-limiting adverse effect of this agent is toxicity to bone marrow, though also associated with fluid retention syndrome consisting of peripheral oedema and/or pleural effusion. – First documented case of non-oedematous maculopathy. – Patients started on Docetaxel therapy should be counselled for possible drug associated toxic maculopathy, and that this should be considered in all patients complaining of visual disturbance. 2. Case report A 56 year old retired theatre nurse under the care of the oncologist for the treatment of advanced breast cancer is referred to our ophthalmology department after complaining of deteriorating vision particularly effecting the left eye. The patient has extensive lymph node and liver metastases for which she is on palliative oral chemotherapy in the form of the anti-mitotic Docetaxel (Taxotere), mainly used in the treatment of breast, ovarian, prostate, and non-small cell lung cancer. The patient was initially diagnosed with breast cancer in December 2009, and underwent a mastectomy soon afterwards. Metastatic spread was discovered in July 2012, and chemotherapy was subsequently initiated in August 2012, on a combination of Docetaxel and steroid. Soon after commencement, the patient began to notice that her vision was starting to deteriorate, with a distinct lack of clarity. The patient initially ignored the symptoms, but in early 2013 visited her opticians felt some changes at the macula were present. It was at this stage that the Oncologists referred the patient for an Ophthalmology opinion, mainly to rule out the presence of choroidal metastases. The patient's chemotherapeutic treatment plan consisted of monthly intravenous infusions of 100?mg/m2 of docetaxel. The patient was on no other concurrent medication, and there was no history of tamoxifen use during the period of chemotherapy. On presentation to the Ophthalmology department, her initial visual acuity was recorded at 6/9-1 in the right eye, and 6/24 in the left (improvement to 6/18 pin-hole). Intraocular pressures were within normal limits. Anterior segment examination was unremarkable, and dilated fundal examination revealed no evidence of vitritis. Dry macular changes were noted in the left eye indicative of toxicity ( Fig. 1 ). This was confirmed on optical coherence tomography (Stratus OCT; Carl Zeiss Meditec, Dublin, CA, USA). Fluorescein angiography exhibited normal filling of the choroidal and retinal vessels and an intact parafoveal capillary net, and no evidence of leakage on late frames ( Fig. 2 ). Electrodiagnostic testing was carried out to confirm macular dysfunction ( Fig. 3 ). Fig. 1.?Fundal photographs displaying Retinal Pigment Epithelium atrophy and hyperpigmentation in an almost “bullseye” pattern in both maculae. Figure options Download full-size image Download as PowerPoint slide Fig. 2.?Intravenous Fluorescein angiography exhibited normal filling of the choroidal and retinal vessels and an intact parafoveal capillary net, with no evidence of leakage on late frames. Figure options Download full-size image Download as PowerPoint slide Fig. 3.?Pattern Electroretinograms (ERG) were consistent with macular dysfunction, marked for the left eye, subtle for the right. Multifocal ERGs show this to be in the form of a well demarcated area of reduced cone function affecting the central 7° or so for the left eye, extending to include the blind-spot; there is evidence of similarly distributed dysfunction affecting the right eye as well, although this is much less marked. Flash ERGs show no evidence of more diffuse retinal dysfunction. Figure options Download full-size image Download as PowerPoint slide The patient denies any past ocular history of note, and has never undergone any intraocular surgery, or ever taken prostaglandin eye drops. Of note in her medical history, the patient is Factor XI deficient. She does not suffer from diabetes. There is no familial ocular history of note. Niacin maculopathy, Goldmann-Favre syndrome, and congenital X-linked retinoschisis were unlikely ot
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