Optical Coherence Tomography Angiographic Findings of Tamoxifen Retinopathy: Similarity with Macular Telangiectasia Type 2

Abstract Purpose We aimed to describe the vascular changes in eyes associated with tamoxifen retinopathy using optical coherence tomography angiography (OCTA) and to compare these changes with abnormalities in macular telangiectasia type 2 (MacTel2) previously reported in the literature. Design Retrospective, observational study Participants Seventeen eyes with tamoxifen retinopathy and 17 eyes of age-matched normal controls. 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-optical coherence tomography (SD-OCT) findings, such as intraretinal cavitation and/or photoreceptor disruption. Multimodal imaging, particularly focused on OCTA, was analyzed. To compare vessel density in OCTA, age-matched normal controls were also 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 them, 17 eyes of 10 patients who were evaluated using OCTA were included. All patients were women, with a mean patient age of 62.2 years. They were treated with tamoxifen as adjuvant endocrine therapy for breast cancer. All eyes had intraretinal cavitation, and eight eyes showed focal photoreceptor disruption, as well, in 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 subjects ( p = 0.003). Crystalline deposits in fundus photograph (12 eyes, 70.6%) and increased autofluorescence in fundus autofluorescence (16 eyes, 94.1%) were also noted as characteristic findings of tamoxifen retinopathy. Conclusions In addition to morphological changes of tamoxifen retinopathy in SD-OCT, its vascular changes in 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 MacTel2.