Abstract

FR.20.04

Uncommon appearance of a tamoxifen-associated maculopathy

Tobias Hager, Stephan Hoffmann, Berthold Seitz

Klinik für Augenheilkunde, Universitätskliniken des Saarlandes, Homburg/Saar

Objective
About 0.6% of patients with systemic tamoxifen therapy develop a retinopathy. Common findings are a remarkable loss of visual acuity combined with crystalline retinal deposits in the macula and a macular edema or crystalline dposits in the peripheral retina.
Methods
We report about a 55 years old female patient with known breast cancer and osseous metastases who presented with bilateral visual loss since 10 months (OD et OS cc 0.2). The patient received a systemic therapy with tamoxifen (20 mg/d) for 7 years.
Results
Biomicroscopic examination displayed a cup-disc-ratio of 0.5 on both sides with known primary open angle glaucoma. In the OCT examination of the right eye, there was a cystoid foveal area with focal disruption of the photoreceptor layer without evidence of a macular edema or thickening. The 30II-perimetry on the right eye was pathologic. Autofluorescence showed no hyperfluorescence. There were no electrophysiological alterations (ERG, mf-ERG) in the sense of a carcinoma associated retinopathy (CAR). In the fluorescence angiography there was a pronounced macular exsudation on both sides in the early phase.
Conclusions
Although tamoxifen associated retinopathy is a arer complication, it is one of the first differential diagnoses if a patient presents with loss of visual acuity and a history of long-term tamoxifen therapy. A selective morphological diagnosis is complicated by the fact that until now, there are only case studies with small patient numbers. Morphological overlaps are therefore common. Especially in patients with known metastasis, the differentiation to CAR is important.

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