TAMOXIFEN RETINOPATHY - DOES IT REALLY EXIST

Background: Tamoxifen retinopathy is known to be an adverse effect of high-dose tamoxifen treatment. Evidence of ocular toxicity at lower do ses is less convincing: the aim of this study was to assess the preval ence of the above-mentioned retinopathy in a population treated with l ow-dose tamoxifen. Methods: One hundred and twenty-nine women treated with low-dose tamoxifen (20 mg/day) were examined. Visual acuity measu rement, slit-lamp biomicroscopy and fundus examination were performed. Patients were reexamined after 6-12 months. Results: Refractile retin al opacities, similar to those previously described as tamoxifen retin opathy, were observed in four patients (prevalence 3.1%; mean duration of therapy 806 days). None of them revealed corneal opacities, papill ary and/or macular edema, or visual impairment. The ophthalmoscopic as pect did not change after a mean follow-up of 215 days, although one o f these patients had interrupted tamoxifen intake. Statistical analysi s (Student's t-test) did not reveal any difference between patients wi th and those without refractile retinal opacities as far as age, treat ment duration and ERG values were concerned. An early hyperfluorescenc e, reminescent of cuticular drusen, was demonstrated by fluorescein an giography in all four cases. Conclusions: The present study would seem to confirm that low-dose tamoxifen may induce retinal toxicity in a l ow proportion of patients, but we cannot be certain that the refractil e retinal opacities observed are really caused by tamoxifen, as differ entiation from age-related macular degeneration with cuticular drusen appears nearly impossible.