Impaired retinal pigment epithelium in paclitaxel-induced macular edema: A case report

RATIONALE: Cystoid macular edema (CME) is a rare complication of the paclitaxel. However, the pathophysiology was unknown. PATIENT CONCERNS: A 60-year-old female presented with bilateral blurred vision due to cystoid macular edema after taking 12-course paclitaxel for her breast cancer. Optical coherence tomography (OCT), fluorescein angiography (FAG), indocyanine green angiography (ICGA), electroretinogram (ERG) and electrooculogram (EOG) were performed. DIAGNOSES: Paclitaxel-induced macular edema. INTERVENTIONS: Paclitaxel was discontinued and supportive treatment with pentoxifylline was given. OUTCOMES: The OCT showed bilateral cystoid macular edema. Impaired filling of choriocapillaries was noted on the ICGA; while EOG revealed decreased Arden ratio. The visual acuity, cystoid macular edema and decreased Arden ratio improved slowly over six months. LESSONS: Paclitaxel rarely causes cystoid macular edema. The damage of choriocapillaries and retinal pigment epithelium might be the underlying cause. Immediate discontinuation of the drug helps visual recovery.