Posters

A case series of tamoxifen-induced crystalline maculopathy

Poster Details

First Author: L.Bourke IRELAND

Co Author(s):    A. Cullinane   M. James                 

Abstract Details

Purpose:

To report a case series of three patients with tamoxifen-induced crystalline maculopathy. We present the history, fundal photos, and ocular coherence tomography (OCT) images of three patients with this uncommon ocular side effect.

Setting:

Ophthalmology department, Cork University Hospital, Ireland

Methods:

Tamoxifen is an oral oestrogen receptor modulator, which is an adjuvant treatment of breast cancer when used in low doses. Ocular side-effects were first reported in 1978 by Kaiser-Kupfer and Lippman. These include keratopathy, cataract, optic neuritis, pseudocystic foveal-cavitation, and crystalline retinopathy with or without macular oedema. The incidence of tamoxifen-related ocular toxicity among patients taking low-dose tamoxifen (20 mg/day) is rare and reported rates vary from 0.9% to 11%. In our case series, two patients presented with a symptomatic reduction in visual acuity, while one patient was referred from the Diabetic Retinal Screening service with diabetic maculopathy.

Results:

All three cases were found to have multiple refractile crystals at the macula, and one case had mild associated macular-oedema. Drug discontinuation was advised in all three of our patients, in consultation with their respective oncologists. The current standard of treatment with tamoxifen for oestrogen-receptor-positive breast cancer is five consecutive years, however the ATLAS (Adjuvant Tamoxifen: Longer against Shorter) trial has showed that ten-years of therapy reduced the risk of recurrence and mortality. This is important because total cumulative dose of tamoxifen and duration of treatment are believed to be the main factors associated with increased incidence of ocular toxicity.

Conclusions:

Discontinuation of tamoxifen may not cause regression of retinal deposits. However, other changes, such as macular oedema, have been reported as being reversible. Clinicians should be aware of tamoxifen-related ocular toxicity and should discuss this risk when commencing treatment. Although a formal screening service is not recommended for patients who are taking tamoxifen, patients should be advised of the risks so that they may seek a prompt ophthalmic review should there be any visual concerns. It may even be prudent to introduce a baseline examination and periodic evaluations in the form of a virtual clinic with OCT scans and fundal-photos.

Financial Disclosure:

None