Toxic maculopathy associated with systemic Carboplatin therapy

Purpose To describe a case of carboplatin-induced macular toxicity occurring during systemic treatment for metastatic non–small cell lung cancer (NSCLC). Methods Retrospective case report with a literature review. Results A 48-year-old man developed bilateral vision loss one week after receiving a second cycle of chemoimmunotherapy consisting of carboplatin, pemetrexed, and pembrolizumab administered intravenously every four weeks. Clinical evaluation revealed rapidly progressive bilateral visual decline with a central scotoma. Multimodal imaging demonstrated foveal hyperautofluorescence and disruption of the foveal ellipsoid zone in both eyes. Electrophysiological testing showed foveal peak impairment on multifocal ERG, consistent with a toxic mechanism. Ocular and systemic findings were not suggestive of a paraneoplastic process. Following discontinuation of carboplatin, anatomical and functional abnormalities stabilized. Conclusion Carboplatin-induced toxic maculopathy is rare and may result in visual acuity loss. Multimodal imaging indicates involvement of foveal photoreceptor. The reversibility of structural and functional changes after treatment cessation remains uncertain.