title: Severe ocular and orbital toxicity after intracarotid injection of carboplatin for recurrent glioblastomas.
abstract: BACKGROUND
  Glioblastoma is a malignant tumor that occurs in the cerebrum during adulthood. With current treatment regimens including combined surgery, radiation and chemotherapy, the average life expectancy of the patients is limited to approximately 1 year. Therefore, patients with glioblastoma sometimes have intracarotid injection of carcinostatics added to the treatment regimen. Generally, carboplatin is said to have milder side effects than cisplatin, whose ocular and orbital toxicity are well known. However, we experienced a case of severe ocular and orbital toxicity after intracarotid injection of carboplatin, which is infrequently reported.
  
  
  METHODS
  A 58-year-old man received an intracarotid injection of carboplatin for recurrent glioblastomas in his left temporal lobe. He complained of pain and visual disturbance in the ipsilateral eye 30 h after the injection. Various ocular symptoms and findings caused by carboplatin toxicity were seen.
  
  
  RESULTS
  He was treated with intravenous administration of corticosteroids and glycerin for 6 days after the injection. Although the intraocular pressure elevation caused by secondary acute angle-closure glaucoma decreased and ocular pain diminished, inexorable papilledema and exudative retinal detachment continued for 3 weeks. Finally, 6 weeks later, diffuse chorioretinal atrophy with optic atrophy occurred and the vision in his left eye was lost.
  
  
  CONCLUSIONS
  When performing intracarotid injection of carboplatin, we must be aware of its potentially blinding ocular toxicity. It is recommended that further studies and investigations are undertaken in the effort to minimize such severe side effects.
authors.affiliation: Department of Ophthalmology, Mazda Hospital, Hiroshima, Japan.
authors.forename: Wataru
authors.initials: W
authors.lastname: Watanabe
authors.forename: Rika
authors.initials: R
authors.lastname: Kuwabara
authors.forename: Toshinori
authors.initials: T
authors.lastname: Nakahara
authors.forename: Osamu
authors.initials: O
authors.lastname: Hamasaki
authors.forename: Ikuo
authors.initials: I
authors.lastname: Sakamoto
authors.forename: Koji
authors.initials: K
authors.lastname: Okada
authors.forename: Atsushi
authors.initials: A
authors.lastname: Minamoto
authors.forename: Hiromu K
authors.initials: HK
authors.lastname: Mishima
mesh_terms: D000970:Antineoplastic Agents / Q000009:adverse effects*; D001766:Blindness / Q000139:chemically induced*; D001932:Brain Neoplasms / Q000188:drug therapy* / Q000473:pathology; D016190:Carboplatin / Q000009:adverse effects*; D002339:Carotid Arteries; D015812:Glaucoma, Angle-Closure / Q000139:chemically induced; D005909:Glioblastoma / Q000188:drug therapy* / Q000473:pathology; D006801:Humans; D007269:Injections, Intra-Arterial; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy*; D009896:Optic Atrophy / Q000139:chemically induced; D009916:Orbital Diseases / Q000139:chemically induced*; D010211:Papilledema / Q000139:chemically induced; D012163:Retinal Detachment / Q000139:chemically induced
chemical_list: D000970:Antineoplastic Agents; D016190:Carboplatin