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Early Detection of Tamoxifen-induced Maculopathy in Patients With Low Cumulative Doses of Tamoxifen.

Pathogenic macula determined by techniques including 3-dimensional optical coherence tomography OCT (3D-OCT), in six breast cancer patients who had received low cumulative doses (4.2 to 9.6 g) of tamoxifen is described. Fluorescein angiography showed varying amounts of foveolar hyperfluorescence. 3-dimensional OCT revealed one or several foveal cystoid spaces in 10 of 12 eyes with or without focal disruption of the photoreceptor transition zones. Time-domain OCT did not indicate cystoid spaces in two of the eyes that clearly showed intraretinal cysts on 3D-OCT. Tiny disruptions of photoreceptor transition zones were also more clearly visible on 3D-OCT. Previous studies have clearly shown retinopathy following long-term or high dosages of tamoxifen. Our results indicate that patients with low cumulative doses of tamoxifen can also suffer visual symptom-related foveal cystoid spaces and/or macular thinning. 3D-OCT is very effective in detecting early subtle changes in tamoxifen-induced maculopathy that can occur in asymptomatic patients.