[Unusual symptoms for tamoxifen-associated maculopathy]

In approximately 0.6-12% of patients systemic tamoxifen therapy is complicated by ocular toxicity. Classical findings include severe loss of visual acuity combined with crystalline retinal deposits in the macula and macular edema or crystalline deposits in the peripheral retina.

We report the case of a 55-year-old female patient with known breast cancer and osseous metastases who presented with bilateral visual loss lasting over 10 months (OD et OS cc 0.2). The patient had received a systemic therapy with tamoxifen (20 mg per day) 7 years ago.

The biomicroscopic examination showed a cup-disc-ratio of 0.5 in both eyes due to primary open angle glaucoma. Optic coherence tomography (OCT) of the right eye revealed a cystoid foveal area with focal lamellar disruption of the photoreceptor layer without evidence of macular edema or thickening. The 30-2 Humphrey visual field of the right eye revealed a mean deviation (MD) of 6.2 dB and a glaucoma-specific absolute scotoma without connection to the blind spot. The visual field of the left eye was inconspicuous (MD 1.1 dB). The left eye showed a perifoveolar area of increased autofluorescence where there was a slight increase of staining in the early phase of fluorescein angiography. The full-field electroretinography was inconspicuous for both eyes.

Although tamoxifen-associated retinopathy is a rare complication of breast cancer therapy it is one of the primary differential diagnoses in a patient presenting with loss of visual acuity and a history of a long standing tamoxifen therapy. Because of the rareness of this disease there are classical examples of tamoxifen-associated ocular toxicity in the literature, but also transient forms which complicate the differential diagnosis. The differentiation from carcinoma-associated retinopathy is particularly important because of the different therapeutic options