Tamoxifen retinopathy and macular telangiectasia: A comparative case series

Purpose To report a case series of tamoxifen retinopathy (TR) with and without type 2 macular telangiectasia (MacTel) and compare their clinical and imaging findings. Methods Retrospective comparative study. Female patients with tamoxifen use or with clinical diagnosis of type 2 MacTel were divided into 4 groups: Group A—tamoxifen use without retinopathy; Group B—tamoxifen use with retinopathy; Group C—type 2 MacTel with tamoxifen use and Group D—type 2 MacTel without tamoxifen use. Clinical and image analysis was conducted. Results There were 6 patients (11 eyes) in group A, 8 (13 eyes) patients in Group B, 2 patients (4 eyes) in Group C and 8 patients (14 eyes) in Group D respectively. TR patients were young, showed retinal crystals, perifoveal greying and no retinal pigment clumps (RPC) on examination. Foveal contour irregularity (n = 13, 100%) and outer retinal layer damage (n = 11, 85%) were common OCT findings seen in TR. In group C, all eyes showed 360° middle retinal layer (MRL) hyperreflectivity (100% vs 86%) and presence of outer retinal hyporeflective cavitation (100% vs 43%) on OCT compared to patients in group D. Abnormal autofluoroscence, detection and leakage from the telangiectatic vessels on fluorescein and OCT angiography was seen in type 2 MacTel disease. Conclusion Patients with TR showed retinal crystals and outer retinal hyporeflective foveal cavitation on OCT. Patients with type 2 MacTel having with tamoxifen intake showed hyporeflective outer retinal foveal cavitation and 360° perifoveal MRL hyperreflectivity on OCT. RPC was observed exclusively in the type 2 MacTel group.