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R. Hera, B. Gonzalvez, M. Tonini, M. Mouillon, J.P. Romanet; Choroidal Neovascularization During Tamoxifen Treatment . Invest. Ophthalmol. Vis. Sci. 2005;46(13):238.
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Purpose:Ocular side effects have already been described in tamoxifen therapy. We report for the first time two cases of patients who developped during tamoxifen treatment choroidal neovascularization associated with inner retinal crystalline deposition or diffuse intraepithelial infiltration. Methods:Patient 1: 72 year old woman receiving tamoxifen as an adjuvant postoperative treatment for breast cancer, reports during the treatment a visual acuity loss in right eye. Fluorescein and ICG angiographic examination showed peripapillar neovascularization associated with macular oedema ,retinal crystalline deposition and diffuse intrepithelial infiltration. Direct photocoagulation was performed . Angiographic findings of neovascularization disappeared without visual acuity improvement because of persistent macular oedema. Few months later the tamoxifen treatment was stopped. Patient 2: 48 year old woman receiving tamoxifen for 2 years additionally to sugery for a breast cancer, report during the treatment a visual loss in right eye. Fluorescein and ICG angiographic examination showed subfoveal choroidal neovascularization associated with diffuse intrepithelial infiltration. Photodynamic therapy was performed. Tamoxifen treatment was stopped. Results: For both patients stopping tamoxifen allowed visual acuity improvement , macular oedema and crystalline deposition decrease. Conclusions: One question can be raised at view of those case reports : Is the choroidal neovascularization an adverse effect of tamoxifen therapy, or is this an independent degenerative pathology? Dramatic improvement of clinical and fundus examination findings occurring only after stopping tamoxifen, supports this idea. As previously shown, oestrogen may function as an inhibitor of the level of VEGF mRNA so we can speculate that antioestrogen may induce neovascularization.
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