Tamoxifen
- PDF / 171,140 Bytes
- 1 Pages / 595.245 x 841.846 pts (A4) Page_size
- 26 Downloads / 157 Views
1 S
Tamoxifen Pachychoroid pigment epitheliopathy and photoreceptor attenuation in both the eyes: case report
An approximately 44-year-old woman developed pachychoroid pigment epitheliopathy and photoreceptor attenuation in both the eyes during treatment with tamoxifen for breast cancer. The woman presented at the age of 49 years with a 5-year history of gradual and progressive visual acuity decrease in both the eyes (more prominent in the right eye). Her best-corrected visual acuities (BCVA) was 20/100 in the right eye and 20/25 in the left eye. Due to breast cancer, she had undergone a right breast mastectomy 7 years prior to the presentation. She had also received systemic adjuvant chemotherapy [details not stated] for 6 months after mastectomy and subsequently received oral tamoxifen 20 mg/day. The cumulative dose of tamoxifen was 51.1g. There was no history of corticosteroid usage. Anterior segment examination was unremarkable but, the fundus examination showed bilateral macular pigmentary changes with diffuse tiny yellow crystals and reduced macular tessellation. On fundus autofluorescence, stippled hypo and hyper autofluorescence area were noticeable in the macular area of the right eye with patchy hyperautofluorescence area inferior to the fovea. There was no significant change in autofluorescence pictures of the left eye. Infrared reflectance images revealed irregular hyperreflective and hyporeflective lesions bilaterally. On spectral-domain optical coherence tomography there was retinal pigment epithelium abnormality and ellipsoid zone discontinuity accompanied with retinal thinning that was more prominent in the right eye. Mild thickening of Haller’s layer was detectable exactly beneath the lesions by enhanced depth imaging optical coherence tomography. Subfoveal choroidal thickness was 343µm in the right eye and 321µm in the left eye. Maximal choroidal thickness was 414µm in the right eye and 365µm in the left eye beneath the retinal pigment epithelium lesions. Fluorescein angiography of the right eye revealed a punctuated hyperfluorescent patch in the central macular area without obvious leakage. Based on these findings, a diagnosis of tamoxifeninduced pachychoroid pigment epitheliopathy was made. Therefore, she was referred to an oncologist to replace tamoxifen. However, three months after the first visit, she continued to receive oral tamoxifen. At that time, her BCVA was found to be deteriorated considerably in both the eyes (right eye: 20/200 and left eye: 20/30). The enhanced depth imaging-optical coherence tomography revealed the progression of the ellipsoid zone disruption in the right eye. Consequently, the woman’s therapy with tamoxifen was stopped. One year later, her visual acuity improved notably to 20/50 in the right eye and 20/25 in the left eye. Examination with spectral-domain optical coherence tomography showed some surprising recoveries in the photoreceptor layers, especially in her right eye. Ghassemi F, et al. Tamoxifen induced pachychoroid pigment epitheliopathy with reversible c
Data Loading...
