• Users Online: 14369
  • Home
  • Print this page
  • Email this page

   Table of Contents      
OPHTHALMIC IMAGE
Year : 2020  |  Volume : 68  |  Issue : 6  |  Page : 1184

Bilateral macular ischemia following oral etoposide


Department of Pediatric Retina and Ocular Oncology, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Coimbatore, Tamil Nadu, India

Date of Web Publication25-May-2020

Correspondence Address:
Dr. Abhishek Das
Department of Pediatric Retina and Ocular Oncology, Aravind Eye Hospital, Avinashi Road, Coimbatore - 641 014, Tamil Nadu
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijo.IJO_1850_19

Rights and Permissions

How to cite this article:
Das A, Ranjan R, Das N, Shah PK. Bilateral macular ischemia following oral etoposide. Indian J Ophthalmol 2020;68:1184

How to cite this URL:
Das A, Ranjan R, Das N, Shah PK. Bilateral macular ischemia following oral etoposide. Indian J Ophthalmol [serial online] 2020 [cited 2024 Mar 28];68:1184. Available from: https://journals.lww.com/ijo/pages/default.aspx/text.asp?2020/68/6/1184/284824



A 29-year-old female presented with bilateral diminution of vision for 3 months duration, the onset of which was sudden after 1 week of starting oral etoposide (50 mg/m 2) for metastatic breast cancer. Best-corrected visual acuity was 5/60 in the right eye and 6/18 in the left eye. Nevertheless, both eyes anterior segments were unremarkable, except grade 1 relative afferent pupillary defect in the right eye. In addition, fundus examination revealed optic disc pallor in the right eye and scattered dot hemorrhages with cotton wool spots in both eyes [Figure 1]a and [Figure 1]b. Fluorescein angiography showed enlarged foveal avascular zone in both eyes with the presence of large capillary nonperfusion area and pruning of vessels at the temporal macula in the right eye, indicating macular ischemia [Figure 1]c and [Figure 1]d.
Figure 1: Fundus examination revealed optic disc pallor in the right eye and scattered dot hemorrhages with cotton wool spots in both eyes. (a and b). Fluorescein angiography showed enlarged foveal avascular zone in both eyes with the presence of large capillary nonperfusion area and pruning of vessels at the temporal macula in the right eye, indicating macular ischemia (c and d)

Click here to view


Although retinal toxicity of many chemotherapeutic drugs has been reported, etoposide alone is not known to cause retinal toxicity.[1],[2],[3],[4],[5] Besides, bilateral sudden onset macular infarction with no evidence of ocular metastasis suggests a direct role of etoposide in this case. The probable mechanism of etoposide toxicity could be due to reduced activity of the UGTA1 enzyme which is responsible for metabolic clearance of etoposide.[6] The oncologist should warn the patients about possible ocular side effects before starting chemotherapy and prompt referral to an ophthalmologist should be warranted in case of ocular complaint.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Kwan AS, Sahu A, Palexes G. Retinal ischemia with neovascularization in cisplatin related retinal toxicity. Am J Ophthalmo1 2006;141:196-7.  Back to cited text no. 1
    
2.
Miller DF, Bay JW, Lederman RJ, Purvis JD, Rogers LR, Tomsak RL. Ocular and orbital toxicity following intracarotid injection of BCND and cisplatinum for malignant gliomas. Ophthalmology 1985;92:402-6.  Back to cited text no. 2
    
3.
Rigal-Sastourne JC, Bidaux F, Mir F, Crepy P, Lucas B, Renard JP, et al. Ocular complications of intracarotid chemotherapies with nitrosourea agents. J Fr Ophtalmol 1993;16:304-10.  Back to cited text no. 3
    
4.
Lauer AK, Wobiq JL, Shults WT, Neuwelt EA, Wilson MW. Severe ocular and orbital toxicity after intracarotid etoposide phosphate and carboplatin therapy. Am J Ophthalmol 1999;127:230-3.  Back to cited text no. 4
    
5.
Martin M, Weber-Varszegi J, Flammer J. Toxic optic neuropathy due to cisplatin therapy: A case report. Klin Monatsbl Augenheilkd 2005;222:244-7.  Back to cited text no. 5
    
6.
Del Re M, Latiano T, Fidilio L, Restante G, Morelli F, Maiello E, et al. Unusual gastrointestinal and cutaneous toxicities by bleomycin, etoposide, and cisplatin: A case report with pharmacogenetic analysis to personalize treatment. EPMA J 2017;8:69-73.  Back to cited text no. 6
    


    Figures

  [Figure 1]


This article has been cited by
1 Efectos secundarios oculares de las terapias oncológicas. Revisión
M. Asencio-Durán, E. Fernández-Gutiérrez, M. Larrañaga-Cores, C. Klein-Burgos, J.V. Dabad-Moreno, M. Capote-Díez
Archivos de la Sociedad Española de Oftalmología. 2023;
[Pubmed] | [DOI]
2 Ocular side effects of oncological therapies: Review
M. Asencio-Durán, E. Fernández-Gutiérrez, M. Larrañaga-Cores, C. Klein-Burgos, J.V. Dabad-Moreno, M. Capote-Díez
Archivos de la Sociedad Española de Oftalmología (English Edition). 2023;
[Pubmed] | [DOI]
3 Potential Ophthalmological Side Effects Induced by Anti-Neoplastic Regimens for the Treatment of Genitourinary Cancers: A Review
Minas Sakellakis, Nikolaos Spathas, Konstantinos T Tsaousis, Emmanouil N Nikitiadis, Helena Linardou, Vasilios F Diakonis
Cureus. 2022;
[Pubmed] | [DOI]
4 Paclitaxel- and/or cyclophosphamide-induced severe ischaemic retinopathy
Abhishek Das, Ratnesh Ranjan, Parag K. Shah, Venkatapathy Narendran
Clinical & Experimental Ophthalmology. 2020; 48(8): 1113
[Pubmed] | [DOI]



 

Top
 
 
  Search
 
    Similar in PUBMED
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this article
References
Article Figures

 Article Access Statistics
    Viewed1127    
    Printed42    
    Emailed0    
    PDF Downloaded121    
    Comments [Add]    
    Cited by others 4    

Recommend this journal