[Unusual symptoms for tamoxifen-associated maculopathy].
BACKGROUND
In approximately 0.6-12% of patients systemic tamoxifen therapy is complicated by ocular toxicity. Classical findings include severe loss of visual acuity combined with crystalline retinal deposits in the macula and macular edema or crystalline deposits in the peripheral retina.


METHODS
We report the case of a 55-year-old female patient with known breast cancer and osseous metastases who presented with bilateral visual loss lasting over 10 months (OD et OS cc 0.2). The patient had received a systemic therapy with tamoxifen (20 mg per day) 7 years ago.


RESULTS
The biomicroscopic examination showed a cup-disc-ratio of 0.5 in both eyes due to primary open angle glaucoma. Optic coherence tomography (OCT) of the right eye revealed a cystoid foveal area with focal lamellar disruption of the photoreceptor layer without evidence of macular edema or thickening. The 30-2 Humphrey visual field of the right eye revealed a mean deviation (MD) of 6.2 dB and a glaucoma-specific absolute scotoma without connection to the blind spot. The visual field of the left eye was inconspicuous (MD 1.1 dB). The left eye showed a perifoveolar area of increased autofluorescence where there was a slight increase of staining in the early phase of fluorescein angiography. The full-field electroretinography was inconspicuous for both eyes.


CONCLUSIONS
Although tamoxifen-associated retinopathy is a rare complication of breast cancer therapy it is one of the primary differential diagnoses in a patient presenting with loss of visual acuity and a history of a long standing tamoxifen therapy. Because of the rareness of this disease there are classical examples of tamoxifen-associated ocular toxicity in the literature, but also transient forms which complicate the differential diagnosis. The differentiation from carcinoma-associated retinopathy is particularly important because of the different therapeutic options
Hager
T
T
Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes, Homburg, Saar. tobias.hager@uniklinikum-saarland.de
Hoffmann
S
S
Seitz
B
B
D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use / Q000633:toxicity*; D001859:Bone Neoplasms / Q000188:drug therapy* / Q000556:secondary*; D001943:Breast Neoplasms / Q000188:drug therapy*; D003460:Crystallization; D003560:Cysts / Q000139:chemically induced* / Q000175:diagnosis; D005260:Female; D005451:Fluorescein Angiography; D006801:Humans; D008134:Long-Term Care; D008875:Middle Aged; D019721:Ophthalmoscopes; D020419:Photoreceptor Cells, Vertebrate / Q000187:drug effects / Q000473:pathology; D012164:Retinal Diseases / Q000139:chemically induced* / Q000175:diagnosis; D013629:Tamoxifen / Q000627:therapeutic use / Q000633:toxicity*; D041623:Tomography, Optical Coherence; D014792:Visual Acuity / Q000187:drug effects*
D018931:Antineoplastic Agents, Hormonal; D013629:Tamoxifen
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