Zeitschrift für klinische und experimentelle Ophthalmologie
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Maculopathy associated with Prior Tamoxifen Use Diagnosed with Commercially Available Fourier-Domain Optical Coherence Tomography: A Case Series

Sanket U. Shah, Lawrence S. Morse and Susanna S. Park

Introduction: Tamoxifen retinopathy is usually diagnosed on fundoscopy and fluorescein angiography. Microcystoid maculopathy associated with tamoxifen was reported previously using a research-grade high resolution Fourierdomain optical coherence tomography (Fd-OCT) in a patient with vision loss unexplained on fundoscopy, fluorescein angiography and Stratus OCT. This report describes two new cases of microcystoid maculopathy diagnosed using commercially available Fd-OCT in patients who have been previously treated with tamoxifen.
Case presentation: Two patients had visual complaints which started while on tamoxifen but persisted or worsened after stopping tamoxifen at least two years earlier. Both patients had normal or near normal visual acuity and fundoscopy. Fluorescein angiography was normal in all but one eye which showed foveal hyperfluorescence. No angiographic cystoid macular edema was noted. Commercially available Fd-OCT (RTVue and Cirrus) showed microcystoid changes in the central macula with patches of loss of photoreceptor inner segment-outer segment junction (IS-OS) near the fovea in all four eyes. The eye with foveal hyperfluorescence on fluorescein angiography had foveal detachment on Fd-OCT in addition which resolved spontaneously on follow-up Fd-OCT nine months later. The microcystoid changes and IS-OS loss persisted on follow-up Fd-OCT.
Conclusion: Maculopathy associated with prior tamoxifen use may be detected using commercial Fd-OCT though not evident on fundoscopy or fluorescein angiography. Maculopathy may persist over 2 years after stopping tamoxifen.