Cystoid Macular Edema following Treatment with Nanoparticle Albumin-Bound Paclitaxel and Atezolizumab for Metastatic Breast Cancer.

Cystoid macular edema (CME) is a rare side effect associated with chemotherapy. Although the development of CME has been reported to occur following treatment with taxane drugs, such as nanoparticle albumin-bound paclitaxel (Nab-PTX), the occurrence of CME with treatment with atezolizumab has not yet been reported. Here, we report the case of a 49-year-old woman who developed CME 19 months into chemotherapy with Nab-PTX and atezolizumab. Improvement was not achieved with steroid injections into the Tenon's sac, and Nab-PTX and atezolizumab treatments were ceased. One month later, there was subjective improvement in her symptoms. Although many reports have indicated that cessation of chemotherapy has successfully improved CME, a specific treatment for CME has not yet been established. Clinicians should be aware of the ophthalmologic side effects and offer immediate treatment if symptoms develop.

Intraocular pressure elevation after intravitreal or posterior sub-Tenon triamcinolone acetonide injection.

BACKGROUND: Despite the benefits of intraocular steroids for the treatment of inflammatory, neovascular, proliferative, and edematous diseases, one of the side effects is raised intraocular pressure (IOP). In this study, we attempted to identify when IOP elevates, peaks, and returns to the preinjection baseline IOP after intravitreal or posterior sub-Tenon administration of triamcinolone acetonide, as well as the factors that might affect IOP. METHODS: Retrospective case review was undertaken of 69 patients (82 eyes), who received either a 4 mg intravitreal (16 eyes) or a 20 mg posterior sub-Tenon (66 eyes) triamcinolone acetonide injection. IOP assessment for each eye was completed at the preinjection baseline and at the first, third, and sixth month of follow-up. RESULTS: The mean IOP of all eyes increased significantly at each follow-up. The mean maximum elevation ratio from the baseline was 4.0 (SD 5.2) mm Hg. An elevation of 5 mm Hg or greater occurred in 28 eyes (34.1%). The maximum elevation correlated significantly with age (p < 0.01). The incidence of an elevation of 5 mm Hg or greater was significantly higher among patients younger than 60 years (p < 0.01) and relatively higher among female patients (p = 0.051). The mean IOP increased significantly at the first month after intravitreal injection but at all follow-up periods after posterior sub-Tenon injection. There was no significant difference in IOP elevation according to disease type, although eyes with diabetic retinopathy tended to be at higher risk of IOP elevation. Two eyes of two female patients, who had received posterior sub-Tenon injections for the treatment of diabetic retinopathy, required glaucoma surgery. INTERPRETATION: The IOP elevation of 5 mm Hg or greater observed in 34.1% of the eyes was consistent with past reports. IOP elevation was associated with patients of less than 60 years of age and with female sex, and it lasted longer after posterior sub-Tenon injection than after intravitreal injection. Careful assessment of IOP during a follow-up period of at least 6 months is paramount, especially in younger female patients after posterior sub-Tenon injection.

Vogt-koyanagi-harada disease with onset in elderly patients aged 68 to 89 years.

BACKGROUND: We present the clinical case reports of elderly Vogt-Koyanagi-Harada (VKH) disease patients, including the oldest patient at onset to date. CASES: Four patients with VKH disease, whose ages at onset were 68 to 89 years, were treated at Kochi Medical School Hospital between December 2002 and September 2004. OBSERVATIONS: Four elderly patients were diagnosed with VKH disease according to the International Revised Diagnostic Criteria for VKH disease. Two were treated with corticosteroid pulse therapy, but the other two could not tolerate high-dose steroid therapy and were treated with only topical corticosteroids. All had recurrences, which were treated effectively. None of these patients experienced recurrence after sunset glow fundus was observed in the follow-up period. CONCLUSIONS: VKH disease is thought to be more common in younger people, but it is not as uncommon in elderly people as is generally believed. Among elderly VKH disease patients, some cannot tolerate high-dose corticosteroid therapy, so we need to treat these patients with only topical corticosteroids.

Platelet-activating factor in human normal tears.

PURPOSE: To measure the concentrations of platelet-activating factor (PAF) and lyso-PAF in tears of human eyes. METHODS: Unilateral tear samples were collected from the conjunctival cul-de-sac of 12 healthy volunteers without any past histories of ocular surface diseases and 10 patients with allergic conjunctivitis (AC) by graduated disposable microcapillaries. C18:0-PAF, C18:0-lyso-PAF, C16:0-PAF, and C16:0-lyso-PAF levels were determined by liquid chromatography-tandem mass spectrometry (LC/MS/MS). RESULTS: The concentrations of C18:0-PAF, C18:0-lyso-PAF, C16:0-PAF, and C16:0-lyso-PAF in tears from healthy volunteers were 0.44 +/- 0.39, 51.7 +/- 63.4, 61.9 +/- 75.9, and 10.7 +/- 14.7 ng/ml, respectively. Higher, but not significantly different, concentrations of all the four kinds of PAF molecules were detected in tears from AC patients. Significant correlations were demonstrated between the concentrations of C18:0-PAF and C18:0-lyso-PAF (r = 0.906; p < 0.01 in normal healthy volunteers and r = 0.939; p < 0.01 in AC patients), and between those of C16:0-PAF and C16:0-lyso-PAF (r = 0.944; p < 0.01 in normal healthy volunteers and r = 0.806; p = 0.015 in AC patients). Moreover, C18:0-PAF concentrations correlated significantly with those of C16:0-PAF (r = 0.885; p < 0.01 in normal healthy volunteers and r = 0.927; p < 0.01 in AC patients), while C18:0-lyso-PAF concentrations correlated significantly with those of C16:0-lyso-PAF (r = 0.972; p < 0.01 in normal healthy volunteers and r = 0.891; p < 0.01 in AC patients). CONCLUSIONS: To our knowledge, this is the first report of the concentrations of different species of PAF (C18:0-PAF, C18:0-lyso-PAF, C16:0-PAF, and C16:0-lyso-PAF) in human tears.