Multimodal imaging features of tamoxifen retinopathy_Chinese Journal of Ocular Fundus Diseases

Authors：

 Liu Changying , Li Lingna , Zhao Xuzheng , Zhang Huaiqiang , Chen Fang

Tangshan Ophthalmological Hospital, Tangshan Institute of Ophthalmology, Eye Hospital Affiliated to North China University of Technology Tangshan City, Tangshan 063000, China;

Corresponding author：

Liu Changying, Email: liuchangying99@163.com

Keywords：

Tamoxifen retinopathy; Fluorescein angiography; Tomography, optical coherence; Regional blood flow; Multimodal image features

DOI：

10.3760/cma.j.cn511434-20220315-00145

Video：

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Objective To observe the multimodal imaging characteristics of tamoxifen retinopathy. Methods A retrospective case study. From January 2019 to December 2021, 4 patients (8 eyes) with tamoxifen retinopathy diagnosed in Tangshan Eye Hospital were included in the study. All patients were female, with sick binoculus. The age was 59.5±4.6 years. After breast cancer resection, tamoxifen 20 mg/d was taken orally consecutively, including 1, 1, and 2 cases who took tamoxifen orally for 5, 7, and ≥10 years. All eyes were examined by fundus color photography, optical coherence tomography (OCT), OCT angiography (OCTA), fundus fluorescein angiography (FFA), and fundus autofluorescence (AF). The multi-mode image features of the fundus of the affected eyes were observed. Results The yellow white dot crystal like material deposition in the macular area was observed in all eyes. In fundus AF examination, macular area showed patchy strong AF. FFA examination showed telangiectasia and fluorescein leakage in macular area at late stage. OCT showed that punctate strong reflexes could be seen between the neuroepithelial layers in the macular region with the formation of a space between the neuroepithelial layers, the interruption of the elliptical zone (EZ), and the formation of a hole in the outer lamella including 4, 5 and 3 eyes; The thickness of ganglion cells in macular region decreased in 7 eyes. OCTA showed that the blood flow density of the superficial retinal capillary plexus around the arch ring was decreased, and the retinal venules were dilated in 2 eyes; Deep capillary plexus (DCP) showed telangiectasia. Conclusion Deposition of yellowish white dot like crystals can be seen in the macular region of tamoxifen retinopathy; dotted strong reflex between neuroepithelial layers, cavity formation, thinning of ganglion cell layer, EZ middle fissure and outer lamellar fissure; DCP capillaries and venules around the arch were dilated; telangiectasia in macular region; flaky strong AF in macular region.

Citation： Liu Changying, Li Lingna, Zhao Xuzheng, Zhang Huaiqiang, Chen Fang. Multimodal imaging features of tamoxifen retinopathy. Chinese Journal of Ocular Fundus Diseases, 2022, 38(11): 901-904. doi: 10.3760/cma.j.cn511434-20220315-00145 Copy

1.	Kaiser-Kupfer MI, Lippman ME. Tamoxifen retinopathy[J]. Cancer Treat Rep, 1978, 62(3): 315-320.
2.	孙功鹏, 易佐慧子, 郑红梅, 等. 双眼他莫昔芬视网膜病变多模式影像检查一例[J]. 中华眼底病杂志, 2021, 37(1): 61-63. DOI: 10.3760/cma.j.cn511434-20190916-00290.Sun GP, Yi ZHZ, Zheng HM, et al. A case of multimodal imaging examination of bilateral tamoxifen retinopathy[J]. Chin J Ocul Fundus Dis, 2021, 37(1): 61-63. DOI: 10.3760/cma.j.cn511434-20190916-00290.
3.	周慧颖, 叶俊杰, 陈有信. 双眼他莫昔芬视网膜病变一例[J]. 中华眼科杂志, 2017, 53(7): 548-550. DOI: 10.3760/cma.j.issn.0412-4081.2017.07.014.Zhou HY, Ye JJ, Chen YX, et al. A case of bilateral tamoxifen retinopathy[J]. Chin J Ophthalmol, 2017, 53(7): 548-550. DOI: 10.3760/cma.j.issn.0412-4081.2017.07.014.
4.	Pavlidis NA, Petris C, Briassoulis E, et al. Clear evidence that long-term, low-dose tamoxifen treatment can induce ocular toxicity[J]. Cancer, 1992, 69(12): 2961-2914. DOI: 10.1002/1097-0142(19920615)69:12<2961::AID-CNCR2820691215>3.0.CO;2-W.
5.	Fraunfelder FT, Meyer SM. Ocular toxicity of antineoplastic agents[J]. Ophthalmology, 1983, 90(1): 1-3. DOI: 10.1016/S0161-6420(83)34600-5.
6.	Cho KS, Yoon YH, Choi JA, et al. Induction of autophagy and cell death by tamoxifen in cultured retinal pigment epithelial and photoreceptor cells[J]. Invest Ophthalmol Vis Sci, 2012, 53(9): 5344-5353. DOI: 10.1167/iovs.12-9827.
7.	Mäenpää H, Mannerström M, Toimela T, et al. Glutamate uptake is inhibited by tamoxifen and toremifene in cultured retinal pigment epithelial cells[J]. Pharmacol Toxicol, 2002, 91(3): 116-122. DOI: 10.1034/j.1600-0773.2002.910305.x.
8.	Goldman D. Müller glial cell reprogramming and retina regeneration[J]. Nat Rev Neurosci, 2014, 15(7): 431-442. DOI: 10.1038/nrn3723.
9.	冯长根, 邓霞飞, 向华, 等. 治疗乳腺癌的抗雌激素药物研究进展[J]. 中国新药杂志, 2006, 15(13): 1051-1057. DOI: 10.3321/j.issn:1003-3734.2006.13.006.Feng CG, Deng XF, Xiang H, et al. Anti-estrogens: current status and trends in the treatment of breast cancer[J]. Chinese Journal of New Drugs, 2006, 15(13): 1051-1057. DOI: 10.3321/j.issn:1003-3734.2006.13.006.
10.	Early Breast Cancer Trialists' Collaborative Group (EBCTCG), Davies C, Godwin J, et al. Relevance of breast cancer hormone receptors and other factors to the efficacy of adjuvant tamoxifen: patient-level meta-analysis of randomised trials[J]. Lancet, 2011, 378(9793): 771-784. DOI: 10.1016/S0140-6736(11)60993-8.
11.	Cronin BG, Lekich CK, Bourke RD. Tamoxifen therapy conveys increased risk of developing a macular hole[J]. Int Ophthalmol, 2005, 26(3): 101-105. DOI: 10.1007/s10792-005-5424-3.
12.	Ritter C, Renner AB, Wachtlin J, et al. Tamoxifen-retinopathie: eine fallserie von klinischen und funktionelle daten[J]. Der Ophthalmologe, 2008, 105(6): 544-549. DOI: 10.1007/s00347-007-1677-8.
13.	Doshi RR, Fortun JA, Kim BT, et al. Pseudocystic foveal cavitation in tamoxifen retinopathy[J]. Am J Ophthalmol, 2014, 157(6): 1291-1298. DOI: 10.1016/j.ajo.2014.02.046.
14.	Li J, Tripathi RC, Tripathi BJ. Drug-induced ocular disorders[J]. Drug Safety, 2008, 31(2): 127-141. DOI: 10.2165/00002018-200831020-00003.
15.	Zvorničanin J, Sinanović O, Zukić S, et al. Tamoxifen associated bilateral optic neuropathy[J]. Acta Neurol Belg, 2015, 115(2): 173-175. DOI: 10.1007/s13760-014-0327-6.
16.	Kaiser-Kupfer MI, Kupfer C, Rodrigues MM. Tamoxifen retinopathy. A clinicopathologic report[J]. Ophthalmology, 1981, 88(1): 89-93. DOI: 10.1016/s0161-6420(81)35071-4.
17.	Gualino V, Cohen SY, Delyfer MN, et al. Optical coherence tomography findings in tamoxifen retinopathy[J]. Am J Ophthalmol, 2005, 140(4): 757-758. DOI: 10.1016/j.ajo.2005.04.042.
18.	Charbel Issa P, Gillies MC, Chew EY, et al. Macular telangiectasia type 2[J]. Prog Retin Eye Res, 2013, 34: 49-77. DOI: 10.1016/j.preteyeres.2012.11.002.
19.	Wang Q, Tuten WS, Lujan BJ, et al. Adaptive optics microperimetry and OCT images show preserved function and recovery of cone visibility in macular telangiectasia type 2 retinal lesions[J]. Invest Ophthalmol Vis Sci, 2015, 56(2): 778-786. DOI: 10.1167/iovs.14-15576.
20.	Powner MB, Gillies MC, Zhu M, et al. Loss of Müller's cells and photoreceptors in macular telangiectasia type 2[J]. Ophthalmology, 2013, 120(11): 2344-2352. DOI: 10.1016/j.ophtha.2013.04.013.
21.	Müller S, Allam JP, Bunzek CG, et al. Sex steroids and macula telangiectasia type 2[J]. Retina, 2017, 38: 1-6. DOI: 10.1097/IAE.0000000000001789.

1. Kaiser-Kupfer MI, Lippman ME. Tamoxifen retinopathy[J]. Cancer Treat Rep, 1978, 62(3): 315-320.
2. 孙功鹏, 易佐慧子, 郑红梅, 等. 双眼他莫昔芬视网膜病变多模式影像检查一例[J]. 中华眼底病杂志, 2021, 37(1): 61-63. DOI: 10.3760/cma.j.cn511434-20190916-00290.Sun GP, Yi ZHZ, Zheng HM, et al. A case of multimodal imaging examination of bilateral tamoxifen retinopathy[J]. Chin J Ocul Fundus Dis, 2021, 37(1): 61-63. DOI: 10.3760/cma.j.cn511434-20190916-00290.
3. 周慧颖, 叶俊杰, 陈有信. 双眼他莫昔芬视网膜病变一例[J]. 中华眼科杂志, 2017, 53(7): 548-550. DOI: 10.3760/cma.j.issn.0412-4081.2017.07.014.Zhou HY, Ye JJ, Chen YX, et al. A case of bilateral tamoxifen retinopathy[J]. Chin J Ophthalmol, 2017, 53(7): 548-550. DOI: 10.3760/cma.j.issn.0412-4081.2017.07.014.
4. Pavlidis NA, Petris C, Briassoulis E, et al. Clear evidence that long-term, low-dose tamoxifen treatment can induce ocular toxicity[J]. Cancer, 1992, 69(12): 2961-2914. DOI: 10.1002/1097-0142(19920615)69:12<2961::AID-CNCR2820691215>3.0.CO;2-W.
5. Fraunfelder FT, Meyer SM. Ocular toxicity of antineoplastic agents[J]. Ophthalmology, 1983, 90(1): 1-3. DOI: 10.1016/S0161-6420(83)34600-5.
6. Cho KS, Yoon YH, Choi JA, et al. Induction of autophagy and cell death by tamoxifen in cultured retinal pigment epithelial and photoreceptor cells[J]. Invest Ophthalmol Vis Sci, 2012, 53(9): 5344-5353. DOI: 10.1167/iovs.12-9827.
7. Mäenpää H, Mannerström M, Toimela T, et al. Glutamate uptake is inhibited by tamoxifen and toremifene in cultured retinal pigment epithelial cells[J]. Pharmacol Toxicol, 2002, 91(3): 116-122. DOI: 10.1034/j.1600-0773.2002.910305.x.
8. Goldman D. Müller glial cell reprogramming and retina regeneration[J]. Nat Rev Neurosci, 2014, 15(7): 431-442. DOI: 10.1038/nrn3723.
9. 冯长根, 邓霞飞, 向华, 等. 治疗乳腺癌的抗雌激素药物研究进展[J]. 中国新药杂志, 2006, 15(13): 1051-1057. DOI: 10.3321/j.issn:1003-3734.2006.13.006.Feng CG, Deng XF, Xiang H, et al. Anti-estrogens: current status and trends in the treatment of breast cancer[J]. Chinese Journal of New Drugs, 2006, 15(13): 1051-1057. DOI: 10.3321/j.issn:1003-3734.2006.13.006.
10. Early Breast Cancer Trialists' Collaborative Group (EBCTCG), Davies C, Godwin J, et al. Relevance of breast cancer hormone receptors and other factors to the efficacy of adjuvant tamoxifen: patient-level meta-analysis of randomised trials[J]. Lancet, 2011, 378(9793): 771-784. DOI: 10.1016/S0140-6736(11)60993-8.
11. Cronin BG, Lekich CK, Bourke RD. Tamoxifen therapy conveys increased risk of developing a macular hole[J]. Int Ophthalmol, 2005, 26(3): 101-105. DOI: 10.1007/s10792-005-5424-3.
12. Ritter C, Renner AB, Wachtlin J, et al. Tamoxifen-retinopathie: eine fallserie von klinischen und funktionelle daten[J]. Der Ophthalmologe, 2008, 105(6): 544-549. DOI: 10.1007/s00347-007-1677-8.
13. Doshi RR, Fortun JA, Kim BT, et al. Pseudocystic foveal cavitation in tamoxifen retinopathy[J]. Am J Ophthalmol, 2014, 157(6): 1291-1298. DOI: 10.1016/j.ajo.2014.02.046.
14. Li J, Tripathi RC, Tripathi BJ. Drug-induced ocular disorders[J]. Drug Safety, 2008, 31(2): 127-141. DOI: 10.2165/00002018-200831020-00003.
15. Zvorničanin J, Sinanović O, Zukić S, et al. Tamoxifen associated bilateral optic neuropathy[J]. Acta Neurol Belg, 2015, 115(2): 173-175. DOI: 10.1007/s13760-014-0327-6.
16. Kaiser-Kupfer MI, Kupfer C, Rodrigues MM. Tamoxifen retinopathy. A clinicopathologic report[J]. Ophthalmology, 1981, 88(1): 89-93. DOI: 10.1016/s0161-6420(81)35071-4.
17. Gualino V, Cohen SY, Delyfer MN, et al. Optical coherence tomography findings in tamoxifen retinopathy[J]. Am J Ophthalmol, 2005, 140(4): 757-758. DOI: 10.1016/j.ajo.2005.04.042.
18. Charbel Issa P, Gillies MC, Chew EY, et al. Macular telangiectasia type 2[J]. Prog Retin Eye Res, 2013, 34: 49-77. DOI: 10.1016/j.preteyeres.2012.11.002.
19. Wang Q, Tuten WS, Lujan BJ, et al. Adaptive optics microperimetry and OCT images show preserved function and recovery of cone visibility in macular telangiectasia type 2 retinal lesions[J]. Invest Ophthalmol Vis Sci, 2015, 56(2): 778-786. DOI: 10.1167/iovs.14-15576.
20. Powner MB, Gillies MC, Zhu M, et al. Loss of Müller's cells and photoreceptors in macular telangiectasia type 2[J]. Ophthalmology, 2013, 120(11): 2344-2352. DOI: 10.1016/j.ophtha.2013.04.013.
21. Müller S, Allam JP, Bunzek CG, et al. Sex steroids and macula telangiectasia type 2[J]. Retina, 2017, 38: 1-6. DOI: 10.1097/IAE.0000000000001789.

Chinese Journal of Ocular Fundus Diseases

Multimodal imaging features of tamoxifen retinopathy

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