POSSIBLE EFFICACY OF TOPICAL DORZOLAMIDE IN THE TREATMENT OF PACLITAXEL-RELATED CYSTOID MACULAR EDEMA

Cystoid macular edema is a rare side effect of the chemotherapeutic drug Paclitaxel. Imaging in Paclitaxel-related CME reveals fluid on ocular coherence tomography scan without leakage on fundus fluorescein angiography, which is in keeping with our findings. There are no recommended treatment guidelines for this condition because of the unclear mechanism of pathology. Treatment strategies have focused on Paclitaxel cessation, which appears to result in spontaneous resolution of CME and improvement in visual acuity. In our patient's case, worsening vision combined with persistent CME and development of retinal pigment epithelial changes after the initial 4 weeks of Paclitaxel cessation indicated that irreversible reduction in vision was a real possibility if we persisted with the drug cessation treatment plan alone. However, a combination of Paclitaxel cessation and topical Dorzolamide 2% TDS (Trusopt) appeared to be effective in reducing her nonresolving CME with no adverse side effects. We can thus postulate that Dorzolamide 2% TDS might have helped to accelerate the resolution of CME, resulting in improved visual acuity, and could be considered as an early treatment option helping to avoid possible irreversible pigmentary changes at the macula that may lead to reduction in vision. Although further research is required, our case report displays a promising treatment strategy and outcome for this rare nonresolving Paclitaxel-related side effect.