Taxane induced cystoid macular edema - 2025 09 12 Non FA leak CME Eunice Shin, MD скачать в хорошем качестве

Taxane induced cystoid macular edema - 2025 09 12 Non FA leak CME Eunice Shin, MD

This presentation reviews the case of a 74-year-old man with metastatic prostate and lung cancer who developed gradual vision loss while undergoing chemotherapy with paclitaxel and carboplatin. Imaging revealed cystoid macular edema with OCT showing cystic spaces and subretinal fluid, but fluorescein angiography was strikingly silent, with no significant leakage. This discordance raised the possibility of drug-induced CME, particularly taxane-related macular edema (TRME), a well-documented but underrecognized ocular toxicity from agents like paclitaxel and docetaxel. The teaching focus is on recognizing the difference between classic CME, which usually demonstrates the “petaloid” leakage pattern on fluorescein angiography, versus angiographically silent CME that can occur in the setting of taxane therapy or retinal dystrophies. The discussion highlights the mechanisms of TRME, thought to involve retinal pigment epithelium and Müller cell dysfunction from microtubule disruption, leading to fluid accumulation without vascular leakage. Key management principles include identifying the systemic trigger, coordinating with oncology for drug discontinuation or dose reduction, and considering adjuvant therapies such as carbonic anhydrase inhibitors to aid recovery. Overall, the case underscores the importance of linking systemic chemotherapy exposures with ocular side effects, using multimodal imaging to guide diagnosis, and remembering that certain forms of CME may be reversible if the offending agent is stopped. Clinicians should keep TRME in the differential when they see bilateral cystic changes on OCT without leakage on FA, especially in patients on taxanes