OCT Angiography Findings of Tamoxifen Retinopathy: Similarity with Macular Telangiectasia Type 2.

PURPOSE

We aimed to describe the vascular changes in eyes associated with tamoxifen retinopathy using OCT angiography (OCTA) and to compare these changes with abnormalities in macular telangiectasia type 2 (MacTel 2) previously reported in the literature.

DESIGN

Retrospective, observational study.

PARTICIPANTS

Seventeen eyes with tamoxifen retinopathy and 17 eyes of age-matched healthy control participants.

METHODS

The medical records of patients who visited the ophthalmology department with a history of taking tamoxifen were reviewed. Tamoxifen retinopathy was diagnosed based on typical spectral-domain (SD) OCT findings, such as intraretinal cavitation, photoreceptor disruption, or both. Multimodal imaging, particularly focused on OCTA, was analyzed. To compare vessel density in OCTA, age-matched normal control participants also were enrolled.

MAIN OUTCOME MEASURES

Descriptive appraisal of the vascular abnormalities and objective quantification of vessel density associated with tamoxifen retinopathy.

RESULTS

Among 292 patients who were screened, 26 were diagnosed with tamoxifen retinopathy. Of these, 17 eyes of 10 patients who were evaluated using OCTA were included. All patients were women, with a median patient age of 65.0 years. They were treated with tamoxifen as adjuvant endocrine therapy for breast cancer. All eyes showed intraretinal cavitation, and 8 eyes showed focal photoreceptor disruption as well, on OCT. On OCTA imaging, 14 eyes (82.4%) showed saccular capillary telangiectasia at the deep capillary plexus and 6 eyes (35.3%) showed right-angled vessels. Foveal vessel density of the superficial plexus was significantly lower in eyes with tamoxifen retinopathy than in control participants (P = 0.003). Crystalline deposits on fundus photographs (12 eyes [70.6%]) and increased autofluorescence on fundus autofluorescence (16 eyes [94.1%]) also were noted as characteristic findings of tamoxifen retinopathy.

CONCLUSIONS

In addition to morphologic changes of tamoxifen retinopathy in SD OCT, its vascular changes on OCTA, such as telangiectatic vascular change at the deep capillary plexus and right-angled vessels, are similar to those observed in the early stages of MacTel 2.