Original article
Pseudocystic Foveal Cavitation in Tamoxifen Retinopathy

https://doi.org/10.1016/j.ajo.2014.02.046Get rights and content

Purpose

To present 3 cases of tamoxifen-induced foveal cavitation and review previous prospective and cross-sectional studies.

Design

Observational case series.

Methods

Retrospective analysis of patients presenting to a single institution with evidence of tamoxifen-induced maculopathy.

Results

Three patients presented with pseudocystic foveal cavitation similar in appearance to macular telangiectasia type 2 on spectral-domain optical coherence tomography (SD OCT) imaging.

Conclusions

Tamoxifen maculopathy is characterized by cavitation in the central macula with or without typical cystoid macular edema. Pathogenesis involves toxicity to retinal Müller cells. It can occur with low daily and cumulative doses of the drug, and in the absence of subjective visual complaints or crystalline retinopathy. Prospective research with SD OCT imaging will be required to gain a more accurate estimate of the incidence of tamoxifen retinopathy.

Section snippets

Methods

This is an observational case series of 3 patients presenting to the Bascom Palmer Eye Institute. The University of Miami Institutional Review Board waived the need for approval based on the limited number of patients involved and the observational nature of the study. The study adhered to the tenets of the Declaration of Helsinki and was in accordance with HIPAA regulations and all federal and state laws.

Case 1

A 63-year-old Haitian woman presented for a second opinion on macular edema. She had not noticed any problem with her vision until 1.5 years prior to presentation, when on routine examination her optometrist could not correct her vision with glasses and sent her to a retina specialist. She was diagnosed with bilateral macular edema and given a single injection of bevacizumab in the right eye. By history, a fluorescein angiogram (FA) was not obtained. She experienced no change in vision from the

Discussion

The hallmark of tamoxifen ocular toxicity was previously thought to be crystalline retinopathy. This association was largely based on clinical findings in patients treated with high-dose tamoxifen. When given in excess of 120 mg daily, tamoxifen can lead to marked crystalline retinopathy and CME.15

Since the standard dose of tamoxifen was reduced to 20 mg daily, there have been fewer reports of clinically significant ocular toxicity. However, recent developments in ocular imaging technology have

Rishi R. Doshi, MD is a medical retina specialist. He received his medical degree from the University of California at San Diego, and completed his residency training at California Pacific Medical Center in San Francisco prior to pursuing a medical retina fellowship at the Bascom Palmer Eye Institute. He served as an Assistant Professor at the Bascom Palmer Eye Institute prior to accepting his current position at the Beaver Medical Group in Redlands, California.

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      Citation Excerpt :

      In a histopathological study223 TAR lesions were localized in the nerve fiber and inner plexiform layers, similar to the crystals in MacTel2. This also supports the fact that the two diseases may be having a common pathogenesis involving Müller cell dysfunction.263,109 Doshi and cowokers109 also pointed out that crystal deposits in TAR were highlighted on blue light fundus reflectance (BLR) imaging that shows areas with macular pigment loss449 suggestive of Müller cell dysfunction.

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    Rishi R. Doshi, MD is a medical retina specialist. He received his medical degree from the University of California at San Diego, and completed his residency training at California Pacific Medical Center in San Francisco prior to pursuing a medical retina fellowship at the Bascom Palmer Eye Institute. He served as an Assistant Professor at the Bascom Palmer Eye Institute prior to accepting his current position at the Beaver Medical Group in Redlands, California.

    Supplemental Material available at AJO.com.

    Rishi R. Doshi is currently at Beaver Medical Group, Redlands, California.

    Brian T. Kim is currently at Harvard Eye Associates, Laguna Hills, California.

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