Department of Ophthalmology, University of Malaya Medical Centre, Lembah Pantai, 59100, Kuala Lumpur, Malaysia.
Department of Ophthalmology, University of Malaya Medical Centre, Lembah Pantai, 59100, Kuala Lumpur, Malaysia.
Breast. 2018 Jun;39:117-122. doi: 10.1016/j.breast.2018.04.003. Epub 2018 Apr 13.
It is now increasingly common for breast cancer patients to receive adjuvant tamoxifen therapy for a period of up to 10 years. As survival rate increases, managing tamoxifen ocular toxicities is important for patients' quality of life. Macular pigments in photoreceptor cells protect against free radical damage, which can cause macular degeneration. By reducing macular pigment concentration, tamoxifen may increase the risk of macular degeneration. Here, we compared macular pigment optical density (MPOD) and central macular thickness between breast cancer patients on tamoxifen adjuvant therapy (n = 70), and a control group (n = 72). Multiple regression analysis indicated that MPOD decreases with increasing tamoxifen dosage, up to a threshold of about 20 g, after which MPOD plateaus out. Mean MPOD in the treatment group (mean = 0.40) was significantly lower (p-value = 0.02) compared to the control group (mean = 0.47) for the left eye, and for the right eye (treatment mean = 0.39; control mean = 0.48; p-value = 0.009). No significant difference in mean central macular thickness was found between the treatment and the control group (p-values > 0.4). In the control group, MPOD and central macular thickness showed significant correlation (r∼0.30; p-values < 0.01) for both eyes. However, in the treatment group, loss of significant correlation was observed in the left eye (r = 0.21; p-value = 0.08). The present results show that MPOD decreases non-linearly as a function of tamoxifen dosage, and highlight the potential of tamoxifen to reduce macular pigment concentration through an unknown mechanism that does not depend on macular thinning solely.
现在，乳腺癌患者接受长达 10 年的辅助他莫昔芬治疗越来越常见。随着生存率的提高，管理他莫昔芬的眼部毒性对于患者的生活质量非常重要。光感受器细胞中的黄斑色素可防止自由基损伤，自由基损伤可导致黄斑变性。他莫昔芬可降低黄斑色素浓度，从而增加黄斑变性的风险。在这里，我们比较了接受他莫昔芬辅助治疗的乳腺癌患者（n=70）和对照组（n=72）的黄斑色素光学密度（MPOD）和中心黄斑厚度。多元回归分析表明，MPOD 随他莫昔芬剂量的增加而降低，在约 20g 左右达到阈值，之后 MPOD 趋于平稳。治疗组的平均 MPOD（均值=0.40）明显低于对照组（左眼均值=0.47；p 值=0.02），右眼的治疗组均值（0.39）也明显低于对照组均值（0.48；p 值=0.009）。治疗组和对照组的平均中心黄斑厚度无显著差异（p 值均>0.4）。在对照组中，双眼的 MPOD 和中心黄斑厚度呈显著相关（r∼0.30；p 值均<0.01）。然而，在治疗组中，左眼的相关性显著丧失（r=0.21；p 值=0.08）。本研究结果表明，MPOD 随他莫昔芬剂量呈非线性降低，提示他莫昔芬可能通过一种未知的、不单纯依赖于黄斑变薄的机制，降低黄斑色素浓度。
