Bilateral Macular Edema in a Patient Treated with Tamoxifen: A Case Report and Review of the Literature

Abstract

We present a case of a 41-year-old female patient with progressive bilateral visual loss. On examination, her best corrected visual acuity (BCVA) in her right eye was 3/10 and her BCVA in her left eye was 2/10. Fundus and optical coherence tomography examination revealed severe bilateral macular edema. She had been diagnosed with breast cancer 6 years ago and was receiving tamoxifen at a dosage of 20 mg/day ever since. Tamoxifen therapy was discontinued, and the patient received 250 mg of acetazolamide three times a day for a period of 1 month. Both foveae regained their normal contour within 2 months, and her vision was restored to 10/10 BCVA 3 months later. To our knowledge, this is the first case reported where bilateral intraretinal macular edema is the only retinal manifestation in a patient on oral tamoxifen.

Uveoretinal Adverse Effects Presented during Systemic Anticancer Chemotherapy: a 10-Year Single Center Experience

“…Although crystalline retinopathy is the best known ocular complication, tamoxifen toxicity can present as a diverse set of conditions, including macular edema, pseudo-cystic cavitation, MH, serous detachment, and vascular occlusion. 5 18 26 27 28 In the present study, tamoxifen maculopathy, which manifested as a retinal cavitation in the fovea, was a common adverse effect, as a single condition caused by a single agent. Following recent marked developments in high-resolution optical coherence tomography scans, this maculopathy induced by low-dose tamoxifen could be visualized.…”

Loratadine-associated cystoid macular edema: A case report

“…Drug-induced CME can be caused by various drugs such as taxanes, 4 acitretin 5 , tamoxifen, 6 niacin 7 , interferon, fingolimod, 8 prostaglandin, epinephrine, and timolol among others. 9 However, systemic anti-histamines- or anti-histamine eye drops-induced CME has not yet been reported.…”

“… 12 , 13 , 14 , 15 Therefore, the mechanisms of drug-induced CME may differ from those of microvascular occlusion or inflammatory disease. The characteristics of drug-induced CME 6 are: (1) often bilateral, (2) no leakage on fluorescence fundus angiography (FFA), (3) a larger cystic space in the outer rather than the inner layer of the retina on OCT scans, and (4) spontaneous resolution and improvement of visual acuity after discontinuation of the causative drug.…”

Drugs Causing Crystalline Retinopathy: Pathogenesis, Diagnosis, and Treatment (Tamoxifen, Canthaxanthin, Methoxyflurane, Nitrofurantoin, Talc)

“…Dirençli vakalarda tekrarlayan enjeksiyonlar gerekebilir. [20][21][22] Maküla ödemi genellikle ilaç kesildikten sonra veya tedaviyle düzelir, ancak kristaller ve kistik kavitasyonlar devam edebilir. [8] Kaiser-Kupfer ve arkadaşları tamoksifenin kesilmesinden sonra klinik lezyonların sayısının ve boyutunun değişmediğini, bu da geri dönüşü olmayan hasarı düşündüğünü bildirmişlerdir.…”