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Show Journal of Nciiro- Oplitlialmology 18( 4): 276, 1998. & 1998 Lippincolt Williams & Wilkins, Philadelphia Tamoxifen Retinopathy Andrew G. Lee, M. D. CASE REPORT A 64- year- old woman had bilateral visual loss. She had received a diagnosis of breast cancer in 1992 and had undergone local surgical resection, axillary lymph node dissection, and local radiotherapy with good results. She was treated with 20 mg adjuvant tamoxifen daily, and there was no evidence of recurrent or metastatic disease. She had not been exposed to canthoxanthine. In June 1997, she had painless, bilateral, progressive loss of visual acuity, with measurements of 20/ 25 right eye and 20/ 60 left eye. Ophthalmoscopy showed a cluster of yellow- white refractile crystals in the macula of each eye Manuscript received March 20, 1998; accepted June 12, 1998. From the Departments of Ophthalmology, Neurology, and Neurosurgery, Baylor College of Medicine, Houston, Texas; and the Department of Neurosurgery, the M. D. Anderson Cancer Center, The University of Texas, Houston, Texas, U. S. A. Address correspondence and reprint requests to Andrew G. Lee, M. D., 6565 Fannin St. NC- 205, Houston, TX 77030, U. S. A. ( Fig. 1). A few perimacular retinal hemorrhages were also noted; the patient had a long history of known diabetes and hypertension. A diagnosis of tamoxifen retinopathy was made, and the tamoxifen was discontinued. Visual acuity did not improve, and the exam has remained stable. Tamoxifen is used in antiestrogen chemotherapy as a treatment for breast cancer. The drug may cause corneal opacity, decreased visual acuity, and crystalline retinopathy. The superficial refractile deposits may represent byproducts of axonal degeneration. In addition, retinal hemorrhages, retinal pigment epithelial changes, and cystoid macular edema may occur. It is not known whether retinal hemorrhages in this patient were related to tamoxifen retinopathy or to underlying diabetes and hypertension. REFERENCE 1. Fraunfelder FT. Drug- induced ocular side effects and drug interactions. 3rd ed. 1989: 401- 2. FIG. 1. Crystalline deposits in the fovea of the right eye ( A). A few retinal hemorrhages are also noted. In addition to the crystalline deposits, perifoveal macular retinal pigment epithelial change is noted in the left eye ( B). 276 |
