Tamoxifen Use in a Patient with Idiopathic Macular Telangiectasia Type 2

Abstract

Crystalline deposits and neurosensory retinal cavitary changes can develop in both tamoxifen retinopathy and nonproliferative idiopathic macular telangiectasia type 2 (MacTel2). MacTel2 is typically differentiated from tamoxifen retinopathy based on the presence of late leakage and mid-phase telangiectatic vessels on fluorescein angiography (FA) and the presence of hyperautofluorescence. Unlike MacTel2, tamoxifen retinopathy is known to be a progressive disease and the cessation of tamoxifen results in resolution of retinopathy. We report a unique case of nonproliferative MacTel2 in a 36-year-old Hispanic woman with tamoxifen use and the vision outcome 30 months after cessation of tamoxifen. The FA and optical coherence tomography angiography findings of this patient support the diagnosis of MacTel2, but her cessation of tamoxifen led to partial reversal of the topographic findings and improvement in visual acuity. This patient is also unique in the unusually young age of presentation for MacTel2. Our case supports that there are common pathways in the pathogenesis of tamoxifen retinopathy and MacTel2, and tamoxifen use could potentially accelerate foveal atrophy in patients with MacTel2.

The response of anti-VEGF therapy and tamoxifen withdrawal of tamoxifen-induced cystoid macular edema in the same patient

“…What cannot be ignored is that a similar etiology between tamoxifen-induced rentinopathy and MacTel2 of decreased serum estrogen concentration and functional damage of Müller cells caused similar symptoms [ 9 , 10 ]. Both of these can present CME and yellow-white deposits.…”

Bilateral Macular Hole Related to Tamoxifen Low-Dose Toxicity

“…FA allows to differentiate retinal changes related to tamoxifen retinopathy, which may be similar on SD-OCT to the ones found in macular telangiectasia type 2 (MacTel2) [9]. Nevertheless, a late leakage of telangiectatic macular capillaries is observed in FA of eyes with MacTel2 [10]. Thus, the diagnosis of bilateral MH related to tamoxifen toxicity was made.…”

Tamoxifen retinopathy and macular telangiectasia: A comparative case series

“…There is another set of publications with contrasting results on the progression of MacTel in patients with and without history of tamoxifen use. 7,8 Behrens et al 7 supported the theory that concurrent tamoxifen use in a type 2 MacTel patient could accentuate the fovea atrophy while another paper by Wolf-Schnurrbusch et al suggested that simultaneous use of tamoxifen in a type 2 MacTel did not hasten the structural changes on OCT in type 2 MacTel cases. 8…”

“…There is another set of publications with contrasting results on the progression of MacTel in patients with and without history of tamoxifen use. 7,8 Behrens et al 7 supported the theory that concurrent tamoxifen use in a type 2 MacTel patient could accentuate the fovea atrophy while another paper by Wolf-Schnurrbusch et al suggested that simultaneous use of tamoxifen in a type 2 MacTel did not hasten the structural changes on OCT in type 2 MacTel cases. 8 In this retrospective study, we intended to compare the clinical and imaging findings of a subset of patients with and without tamoxifen retinopathy and another subset of patients with type 2 MacTel with and without history of tamoxifen use.…”