Korean J Ophthalmol.  2010 Oct;24(5):306-309. 10.3341/kjo.2010.24.5.306.

Estrogen Antagonist and Development of Macular Hole

• Chung SE
• Kim SW
• Chung HW
• Kang SW

• KMID: 974326
• DOI: http://doi.org/10.3341/kjo.2010.24.5.306

Abstract

To describe the clinical and optical coherence tomography (OCT) features of a macular hole (MH) or its precursor lesion in patients treated with systemic antiestrogen agents. We reviewed the medical history of the patient, ophthalmic examination, and both fundus and OCT findings. Three female patients receiving antiestrogen therapy sought treatment for visual disturbance. All of the patients showed foveal cystic changes with outer retinal defect upon OCT. Visual improvement was achieved through surgery for the treatment of MH in two patients. Antiestrogen therapy may result in MH or its precursor lesion, in addition to perifoveal refractile deposits. OCT examination would be helpful for early detection in such cases.

Keyword

Antiestrogen agent; Foveal cyst; Retinal perforations; Tamoxifen; Toremifen

MeSH Terms

Adult
Breast Neoplasms/drug therapy/surgery
Estrogen Antagonists/*adverse effects
Female
Humans
Middle Aged
Retinal Perforations/*chemically induced/diagnosis/surgery
Tamoxifen/*adverse effects
Vitrectomy

Figure

• 

  Fig. 1 Fundus photograph and optical coherence tomographic images of both eyes of patient 1. (A,C) At presentation, the image shows foveal cystic changes with outer retinal defect in the patient's right eye. (B,D) At presentation, the image shows a stage 1b macular hole in the left eye. (E) The enlargement of outer foveal defect is noted in the right eye 4 months after initial presentation, with further deterioration of vision. (F) However, improved foveal contour and vision is noted after macular hole surgery in the left eye. (G,H) The closure of macular hole is achieved in both eyes after completing the surgery in both eyes.

• 

  Fig. 2 Right eye of patient 2. Fundus photographic image (A) shows foveal cystic change, and the optical coherence tomographic image (B) shows a focal outer retinal defect at initial presentation. The contour of the fovea returns to normal after macular hole surgery.

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  Fig. 3 Fundus photographic images of both eyes in patient 3. At initial presentation, small multiple refractile deposits are noted in both of the patient's eyes (A,B). Optical coherence tomographic (OCT) scan of the macula shows no specific abnormality in the right eye (C); however, a focal defect of the outer retinal layer is noted in the left eye (D). No interval change in OCT findings is noted after 5 months (E).

Reference

1. Bourla DH, Sarraf D, Schwartz SD. Peripheral retinopathy and maculopathy in high-dose tamoxifen therapy. Am J Ophthalmol. 2007. 144:126–128.

2. Gualino V, Cohen SY, Delyfer MN, et al. Optical coherence tomography findings in tamoxifen retinopathy. Am J Ophthalmol. 2005. 140:757–758.

3. Cronin BG, Lekich CK, Bourke RD. Tamoxifen therapy conveys increased risk of developing a macular hole. Int Ophthalmol. 2005. 26:101–105.

4. Bernstein PS, DellaCroce JT. Diagnostic & therapeutic challenges. Tamoxifen toxicity. Retina. 2007. 27:982–988.

5. Evans JR, Schwartz SD, McHugh JD, et al. Systemic risk factors for idiopathic macular holes: a case-control study. Eye (Lond). 1998. 12(Pt 2):256–259.

6. The Eye Disease Case-Control Study Group. Risk factors for idiopathic macular holes. Am J Ophthalmol. 1994. 118:754–761.