Tamoxifen
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Tamoxifen Bilateral macular hole: case report
A 63-year-old woman developed bilateral macular hole following adjuvant therapy with tamoxifen for breast cancer. The woman with no prior ocular history, presented with mild, progressive, bilateral visual loss for years (current presentation). At the age of 41 years, she was diagnosed with breast cancer. Thereafter, she underwent mastectomy. After mastectomy, she was started on low dose tamoxifen therapy 20mg daily as adjuvant therapy [route not stated]. She received the tamoxifen therapy for approximately 10 years (cumulative dose around 73g), which was then stopped about 12 years prior to the current presentation. Examinations at the time of current presentation showed best corrected visual acuity of 20/40 in both eyes. Slit lamp examination of the anterior segment was unremarkable. A dilated fundus examination revealed an irregular foveal light reflex with pseudohole appearance without any evidence of reflective deposits in the inner layers.A bilateral macular hole with a thin overlying roof of the inner retinal remnant was detected by spectral-domain optical coherence tomography. Small cystic spaces on the edges of the hole, and an attachment of the posterior hyaloid was noted without any signs of thickening or macular oedema. Fluorescein angiography showed a progressive and diffuse hyperfluorescence in the fovea of both her eyes without any late phase leakage. Fluorescein angiography showed differential retinal changes related to tamoxifen retinopathy. Fluorescein angiography also showed a late leakage of telangiectatic macular capillaries in both the eyes with macular telangiectasia type II. Based on the examinations, a diagnosis of bilateral macular hole related to the tamoxifen therapy was diagnosed. The woman underwent a 23-gauge pars plana vitrectomy in her right eye, and rested for 6 days in a prone position. After the surgery, the macular hole remained opened along with elevated edges. Another 23-gauge pars plana vitrectomy was proposed; however, she denied. During follow-ups for the following 4 years, no changes were noted in her visual acuity or spectral-domain optical coherence tomography images. Belzach NT, et al. Bilateral macular hole related to tamoxifen low-dose toxicity. Case Reports in Ophthalmology : 528-533, Jan 2020. Available from: URL: http:// doi.org/10.1159/000508327
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Reactions 21 Nov 2020 No. 1831
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