Unilateral Optic Disc Papilloedema following Administration of Carboplatin Chemotherapy for Ovarian Carcinoma
A 48-year-old woman with a positive BRCA1 gene mutation was referred with a pelvic mass. Ca-125 was >4,000 and a CT scan confirmed the presence of large bilateral ovarian tumours. She underwent debulking surgery, and histology revealed completely resected stage 3b high-grade endometrioid ovarian carcinoma. She was therefore referred to Oncology for consideration of adjuvant chemotherapy. She was well, with a performance status of 0 and no medical history of note. EDTA glomerular filtration rate was measured to be 98 ml/min.\nShe was prescribed the regime of weekly paclitaxel 80 mg/m2 (total dose 150 mg) with concurrent 3-weekly carboplatin AUC 6 (total dose 740 mg) []. During the first cycle of paclitaxel, she suffered an immediate allergic reaction; therefore, subsequently her regime was switched to single-agent carboplatin at the previously calculated dose. She received 2 cycles without incident, but her third cycle was delayed by 1 week owing to thrombocytopaenia (platelet count 77 × 109/l), and her fourth was delayed by a further week due to neutropaenia (neutrophil count 0.9 × 109/l). At review prior to her fourth cycle, she mentioned an incidental finding of a blot haemorrhage at a routine optometrist visit, which was asymptomatic. Diabetic screening was performed at this stage in view of a strong family history, but was negative.\nFive days after her fifth cycle of carboplatin, she awoke with new-onset blurred vision in her left eye. An ophthalmology review showed left-sided disc oedema (fig. ) with normal optic nerve function tests and 6/24 visual acuity. No abnormality was seen in the right eye with 6/6 visual acuity. A CT scan of the head and orbits was performed which showed no evidence of metastases or raised intracranial pressure. An autoimmune screen was performed which did not reveal any explanation for her visual symptoms. Fundus fluorescein angiography showed bilateral intense late disc leakage with no evidence of vasculitis (fig. ). In view of her low platelet count and no clinically evident disc oedema in the right eye, a lumbar puncture was not performed.\nThe diagnosis was felt to be that of carboplatin-induced unilateral disc oedema. At this point, her chemotherapy was stopped in view of a radiological and biochemical remission and her visual symptoms were monitored. She was also started on prednisolone 40 mg daily. Her symptoms did not improve with steroids, however, and the dose was gradually tapered down. Five months after the initial review, she has developed left optic disc atrophy with 6/18 visual acuity, while the right eye remains asymptomatic.