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Research Letters | July 2012

Bevacizumab Therapy for Tamoxifen-Induced Crystalline Retinopathy and Severe Cystoid Macular Edema

Ehsan Rahimy, MD; David Sarraf, MD

Arch Ophthalmol. 2012;130(7):931-932. doi:10.1001/archophthalmol.2011.2741.

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Tamoxifen citrate, an oral antiestrogen, is most commonly used in low dosages (20 mg/d) as an adjuvant therapy for breast cancer. At significantly higher dosages (200 mg/d), it has also been used to treat malignant astrocytoma of the brain.¹ Of its well-documented ocular toxic effects, potentially the most devastating is the development of crystalline maculopathy with associated cystoid macular edema (CME).² Treatment consists of cessation of the medication, which may stabilize vision but rarely results in its recovery. We describe the first reported case, to our knowledge, of severe tamoxifen-induced CME resolved with intravitreal bevacizumab (Avastin) therapy.

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Figure. Tamoxifen maculopathy and cystoid macular edema. Initial color fundus photographs of the right (A) and left (B) eyes show refractile deposits in the perifovea surrounding honeycomb-like spaces (reproduced with permission by Elsevier from Am J Ophthalmol. 2007;144[1]:126-128). Stratus optical coherence tomography confirms severe cystoid macular edema in the right (C) and left (D) eyes. Color fundus photographs 4 years after initiating treatment with 6 intravitreal bevacizumab injections in the right eye (E) and 12 injections in the left eye (F) demonstrate marked resolution of the crystalline deposits and adjacent cystic spaces. Corresponding Cirrus high-definition optical coherence tomographic scans reveal normal foveal architecture in the right (G) and left (H) eyes. I indicates inferior; N, nasal; S, superior; and T, temporal.

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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 Credit^TM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 Credit^TM.

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Rahimy E, Sarraf D. Bevacizumab Therapy for Tamoxifen-Induced Crystalline Retinopathy and Severe Cystoid Macular Edema. Arch Ophthalmol. 2012;130(7):931-932. doi:10.1001/archophthalmol.2011.2741.

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