Severe ocular and orbital toxicity after intracarotid injection of carboplatin for recurrent glioblastomas.
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.
Watanabe
Wataru
W
Department of Ophthalmology, Mazda Hospital, Hiroshima, Japan.
Kuwabara
Rika
R
Nakahara
Toshinori
T
Hamasaki
Osamu
O
Sakamoto
Ikuo
I
Okada
Koji
K
Minamoto
Atsushi
A
Mishima
Hiromu K
HK
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
D000970:Antineoplastic Agents; D016190:Carboplatin