Occam Versus Hickam: Irreversible Vision Loss From Paclitaxel-Induced Cystoid Macular Edema

Purpose: To describe a case of cystoid macular edema (CME) caused by paclitaxel, a first-line chemotherapeutic for invasive breast cancer. Methods: A single case was presented. Results: CME developed shortly after initiation of paclitaxel; 7 months after discontinuation, improvement was seen. However, the patient’s visual acuity never recovered. Changes consistent with macular telangiectasia, which may have been potentiated by paclitaxel toxicity, were seen on multimodal imaging. Conclusions: This is the first reported case of irreversible vision loss after paclitaxel treatment without evidence of phototoxicity. Paclitaxel may exacerbate underlying macular telangiectasia, resulting in ellipsoid zone loss after recovery from CME.