Bilateral blindness and lumbosacral myelopathy associated with high-dose carmustine and cisplatin therapy.
OBJECTIVE
To report the early ocular pathologic findings associated with high-dose carmustine and cisplatin therapy.


METHODS
A patient with metastatic breast carcinoma developed an acute onset of branch retinal artery occlusion, bilateral blindness, and a myelopathy involving the lower extremities after high-dose chemotherapy and bone marrow transplant.


RESULTS
Histopathologic examination of the eye and optic nerves at autopsy disclosed nerve fiber layer infarction secondary to right inferior temporal retinal artery thrombosis. Patchy necrosis of both optic nerves, medulla oblongata, and spinal cord was associated with focal small-vessel thrombosis.


CONCLUSIONS
The syndrome of retinal vascular occlusion, optic neuropathy, and myelopathy is associated with the high-dose chemotherapeutic agents carmustine and cisplatin. The distribution of necrosis suggests an ischemic event rather than direct neurotoxic effects.
Wang
M Y
MY
Jules Stein Eye Institute, Department of Ophthalmology, UCLA School of Medicine, Los Angeles, California, USA.
Arnold
A C
AC
Vinters
H V
HV
Glasgow
B J
BJ
D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects*; D001766:Blindness / Q000139:chemically induced* / Q000473:pathology; D001943:Breast Neoplasms / Q000628:therapy; D018270:Carcinoma, Ductal, Breast / Q000628:therapy; D002330:Carmustine / Q000009:adverse effects*; D002945:Cisplatin / Q000009:adverse effects*; D003131:Combined Modality Therapy; D017809:Fatal Outcome; D005260:Female; D005451:Fluorescein Angiography; D006801:Humans; D008161:Lumbosacral Region; D008408:Mastectomy; D008875:Middle Aged; D009901:Optic Nerve Diseases / Q000139:chemically induced / Q000473:pathology; D015356:Retinal Artery Occlusion / Q000139:chemically induced* / Q000473:pathology; D013118:Spinal Cord Diseases / Q000139:chemically induced* / Q000473:pathology; D014792:Visual Acuity
D002945:Cisplatin; D002330:Carmustine