Retinal Microvascular and Microstructural Alterations in Lung Cancer Patients Treated with Albumin-Bound Paclitaxel: A Novel OCTA Approach

Abstract Purpose This study aimed to conduct a comprehensive investigation into the retinal microvascular and microstructural alterations, particularly retinal thickness and vascular density, in lung cancer (LC) patients treated with albumin-bound paclitaxel (ABP),and to explore their potential as biomarkers for disease monitoring and treatment evaluation. Methods A total of 20 healthy controls (HCs group, 40 eyes), 20 untreated LC patients (LC group, 40 eyes), and 20 LC patients treated with ABP (ABP group, 40 eyes) were enrolled in this study.Retinal thickness and superficial vessel density (SVD) were analyzed by optical coherence tomography angiography (OCTA) in nine subregions defined by the Early Treatment Diabetic Retinopathy Study (ETDRS) protocol.Statistical analyses included one-way ANOVA and Bonferroni correction for multiple comparisons as well as receiver operating characteristic curve analyses to compare groups and assess the diagnostic accuracy of measured parameters. Results Retinal microvessel density was significantly lower in LC patients compared to HCs (p < 0.001), and further lower in patients in the ABP group (p < 0.001).ROC analysis demonstrated high diagnostic accuracy in differentiating groups based on retinal thickness and SVD (area under the curve, AUC > 0.7). Dry eye parameters, including tear break-up time (tBUT), Schirmer test (SIT), and tear meniscus height (TMH), were significantly impaired in both the LC and ABP groups compared to HCs (p < 0.001), with no significant improvement observed after ABP treatment. Conclusion OCTA is effective in detecting retinal microvascular changes in LC patients that are exacerbated by ABP treatment. These findings suggest that retinal changes can be used as an adjunctive biomarker to monitor disease progression and treatment-related toxicity in patients with LC.