Wolf-Schnurrbusch Ute E K, Leung Irene, Sallo Ferenc B, Clemons Traci E, Chew Emily Y, Bird Alan C, Peto Tunde
Universtätsklinik für Augenheilkunde, University of Bern, Bern, Switzerland.
Ophthalmic Res. 2018;60(1):38-42. doi: 10.1159/000479932. Epub 2017 Sep 13.
To investigate the influence of hormone therapy with tamoxifen or estrogens on morphological changes in macular telangiectasia (MacTel) type 2 patients as revealed clinically in multiple imaging modalities.
Patients with a history of tamoxifen or estrogen use were selected from the cohort of the MacTel Study. A race-, age- and best-corrected visual acuity-matched group of MacTel participants not under hormone therapy served as the comparison group. The frequencies of typical features of the MacTel phenotype apparent in color fundus, red-free, fluorescein angiographic and optical coherence tomographic images were graded and analyzed statistically.
Thirty-nine MacTel patients were included in the analyses, of whom 13 were receiving tamoxifen, 13 estrogens and 13 patients no hormone treatment. Patients treated with estrogens showed significantly fewer breaks in the ellipsoid zone on optical coherence tomography (7 eyes, 29.1%, vs. tamoxifen: 14 eyes, 53.8%, and vs. controls: 14 eyes, 53.8%, p = 0.04 in both analyses, Fisher exact test). Retinal crystalline deposits were significantly more frequent in patients receiving estrogens (12 eyes, 16.2%, vs. 2 eyes, 2.7%, p = 0.003, Fisher exact test). No significant between-group differences were apparent with regard to other features of the phenotype (extent of retinal low reflective spaces, late hyperfluorescence on fluorescein angiography or retinal thickness).
Tamoxifen treatment does not seem to accentuate structural changes in patients with MacTel type 2. Treatment with estrogens may exhibit a neuroprotective effect as suggested by the decreased frequency of ellipsoid zone breaks in corresponding patients, although corroborative studies are warranted to confirm these exploratory data.
研究他莫昔芬或雌激素激素疗法对2型黄斑毛细血管扩张症（MacTel）患者形态学变化的影响，这些变化通过多种成像方式在临床上得以揭示。
从MacTel研究队列中选取有他莫昔芬或雌激素使用史的患者。将未接受激素治疗的MacTel参与者按种族、年龄和最佳矫正视力匹配成组作为对照组。对彩色眼底、无赤光、荧光素血管造影和光学相干断层扫描图像中明显的MacTel表型典型特征的频率进行分级并进行统计学分析。
39例MacTel患者纳入分析，其中13例接受他莫昔芬治疗，13例接受雌激素治疗，13例未接受激素治疗。接受雌激素治疗的患者在光学相干断层扫描中椭圆体带的断裂明显较少（7只眼，29.1%，他莫昔芬组：14只眼，53.8%，对照组：14只眼，53.8%，两项分析中p = 0.04，Fisher精确检验）。接受雌激素治疗的患者视网膜结晶沉积物明显更常见（12只眼，16.2%，而2只眼，2.7%，p = 0.003，Fisher精确检验）。在表型的其他特征方面（视网膜低反射区范围、荧光素血管造影晚期高荧光或视网膜厚度），组间无明显差异。
他莫昔芬治疗似乎不会加重2型MacTel患者的结构变化。雌激素治疗可能表现出神经保护作用，相应患者椭圆体带断裂频率降低表明了这一点，尽管需要进一步的对照研究来证实这些探索性数据。
