Retinal structural changes in patients receiving tamoxifen therapy by spectral-domain optical coherence tomography

Bölükbaşı, Selim; Gürsel, Özge Kandemir; Çakir, Akın; Erden, Burak; Karatas, Gamze

doi:10.1080/15569527.2020.1734816

Cited by 13 publications

(6 citation statements)

References 32 publications

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“…Based on several case series studies, the most frequently used estrogen inhibitor, Tamoxifen, had been reported to induce CSC. 23 , 24 However, no solid evidence demonstrated that estrogen would promote progression of CSC. The prevalence of vascular diseases in postmenopausal women was much higher than that in premenopausal women of the same age 25 , 26 and this evidence suggests a relationship between circulating estrogen levels and the change of vascular function in women.…”

Section: Discussionmentioning

confidence: 99%

The Association Between Circulating Sex Hormones and Central Serous Chorioretinopathy: A Case-Control Study

Zhao¹,

Huang²,

Chen³

et al. 2022

TCRM

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Background: Central serous chorioretinopathy (CSC) is preferential cocurated in males, however the associations between sex hormones and CSC incidence or progression remains unclear. The sex hormone concentration assessments in CSC cases and healthy controls will update the knowledge in CSC management. Methods: This case-control study included 59 CSC cases and 30 healthy controls, from January 2019 to December 2020. The CSC cases would be defined as spontaneous resolved if the subretinal fluid were absorbed within three months. The concentrations of total testosterone (TT), free testosterone (FT), estradiol (E2), sex hormone-binding globulin (SHBG), progesterone, leuteinizing hormone (LH) and dehydroepiandrosterone sulfate (DHEA-S) were detected in all the participants. The relationships between sex hormone concentrations and CSC-related characteristics were analyzed with Pearson correlation analyses. Results: Significantly increased TT, FT, FT/E2 ratio, SHBG concentrations as well as decreased DHEA-S level were detected in nonresolved CSC group compared with the control group. Comparing with the resolved ones, it was found that TT, FT and SHBG concentrations were increased in the non-resolved CSC. A significant positive correlation between TT concentrations and CMT (R 2 =0.168, P=0.031) as well as SRF height (R 2 =0.146, P=0.045) were detected in the non-solved CSC group. Conclusion: Different concentrations of TT, FT, FT/E2 ratio, DHEA-S and SHBG were detected in resolved and non-resolved CSC cases. Sex hormones were related to CSC symptom durations and related parameters.

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Section: Discussionmentioning

confidence: 99%

The Association Between Circulating Sex Hormones and Central Serous Chorioretinopathy: A Case-Control Study

Zhao¹,

Huang²,

Chen³

et al. 2022

TCRM

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“…The mean age of the users was 45.0 years, with the highest proportion being 40-49 years old. The mean duration of tamoxifen use in our population was 36.0 months, indicating a significant period of medication exposure that is deemed sufficient to cause tamoxifen retinopathy according to the literature [2,[15][16][17]. These data underscore the clinical significance of retinopathy screening for tamoxifen users, particularly in light of the escalating prevalence of breast cancer worldwide.…”

Section: Discussionmentioning

confidence: 50%

“…Funduscopy/fundus photography is the most commonly used modality for baseline screening and subsequent monitoring, indicating its widespread availability and ability to detect crystalline retinopathy with sensitivity [1,18]. However, the limited utilization of OCT shown in our data (21.9% at baseline and 29.6% for subsequent monitoring) may result in the failure to detect the subtle retinal changes associated with tamoxifen use [11,15]. For instance, tamoxifen retinopathy can present with pseudocystic foveal cavitation or photoreceptor disruption in OCT [2,19,20], in addition to typical refractile crystalline depositions in fundus photographs (crystalline retinopathy).…”

Section: Discussionmentioning

confidence: 83%

Nationwide Screening Practices for Tamoxifen Retinal Toxicity in South Korea: A Population-Based Cohort Study

Ahn,

Kim,

Kwon

2024

JCM

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(1) Background/Objectives: To investigate the nationwide screening practices and trends in tamoxifen retinal toxicity (tamoxifen retinopathy) in South Korea using national health insurance claims data. (2) Methods: A total of 43,848 patients who started tamoxifen therapy between 2015 and 2020 and had no prior ophthalmic diseases or other conditions requiring screening for retinopathy were included. The annual numbers of tamoxifen users and new initiators of tamoxifen therapy were assessed. The screening examinations were separated into baseline (first ophthalmic examination after tamoxifen administration) and subsequent monitoring examinations. The timing and modalities for the baseline and subsequent monitoring examinations performed between 2015 and 2021 were assessed in tamoxifen users. (3) Results: The annual number of tamoxifen users increased over the study period from 54,056 in 2015 to 81,720 in 2021. The number of patients who underwent ophthalmic examination after tamoxifen administration was 8961 (20.4%). Baseline screening was performed in 6.5% of patients within 1 year of use, and subsequent monitoring was performed in 27.8% of patients who underwent baseline screening. Funduscopy or fundus photography was performed most commonly for baseline screening and subsequent monitoring (99.0% and 98.6%, respectively), while optical coherence tomography was performed only in 21.9% and 29.6% of baseline and monitoring examinations, respectively. The average number of monitoring examinations per year was 0.68 ± 0.45. Although the annual percentage of patients receiving a baseline examination within 1 year gradually increased over time, the percentage of those with subsequent monitoring performed within 1 year was similar over the study period. (4) Conclusions: Our finding, appropriate screening in a small proportion of patients receiving tamoxifen, suggests the need to promote awareness among healthcare professionals and develop a standardized approach for screening for tamoxifen retinopathy.

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“…Tamoxifen has been associated with numerous ophthalmological side effects, most notably crystalline retinopathy. Spectral domain optical coherence tomography was used by Bolukbasi et al ., to document changes in the retinal and choroidal layers before development of retinal pathology 29 . Tamoxifen usage for a mean duration of 4 years in patients with breast cancer has been associated with increased subfoveal, nasal and temporal CT as far as 1500 μm from the fovea centralis.…”

Section: Resultsmentioning

confidence: 99%

“…Spectral domain optical coherence tomography was used by Bolukbasi et al, to document changes in the retinal and choroidal layers before development of retinal pathology. 29 Tamoxifen usage for a mean duration of 4 years in patients with breast cancer has been associated with increased subfoveal, nasal and temporal CT as far as 1500 μm from the fovea centralis. Of those taking tamoxifen, 75% of patients were classified as having uncomplicated pachychoroid as defined by a thickness >300 μm.…”

Section: Antineoplastic Agentsmentioning

confidence: 99%

The effect of systemic and topical ophthalmic medications on choroidal thickness: A review

Yeung

Park

et al. 2022

Brit J Clinical Pharma

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The choroid plays an important role in various ocular pathologies and retinal blood supply. There is a knowledge gap on how the choroid is affected by systemic and topical medications. Systemic medications that affect microvasculature elsewhere in the body can also affect the microvasculature of the choroid. This review summarizes current knowledge on associations between systemic and topical medications and changes in choroidal thickness (CT). This review included 71 studies on mydriatics/cycloplegics, intraocular pressure (IOP)‐lowering therapies, antihypertensives, adrenergic antagonists, statins, corticosteroids, hydroxychloroquine, isotretinoin, hormonal contraceptives, phosphodiesterase inhibitors, antipsychotics, antineoplastic agents, ethanol, caffeine and nicotine. IOP‐lowering therapies, atropine eye drops, and systemic administration of β blockers and ethanol are associated with a significant increase in CT. Cyclopentolate and phenylephrine are associated with a CT reduction. Systemic medications that decrease CT include caffeine and nicotine. Tropicamide, angiotensin‐converting enzyme inhibitors, angiotensin receptor blockers, statins, corticosteroids, hydroxychloroquine and hormonal contraceptives have mixed findings. CT increase associated with IOP‐lowering therapies is possibly achieved by enhancing aqueous humour flow to the choroid thus elevating choroidal blood flow and thickness. CT changes appear to be independent from systemic blood pressure changes, suggesting that a significant association with an antihypertensive could be due to an idiosyncratic drug property. Statins and candesartan decrease macrophage accumulation and intercellular adhesion molecule 1 expression in the choroid. The choroid and its response to various disease processes and systemic medication can be further investigated to improve patient care, particularly in patients with choroid and retina pathologies.

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Retinal structural changes in patients receiving tamoxifen therapy by spectral-domain optical coherence tomography

Cited by 13 publications

References 32 publications

The Association Between Circulating Sex Hormones and Central Serous Chorioretinopathy: A Case-Control Study

The Association Between Circulating Sex Hormones and Central Serous Chorioretinopathy: A Case-Control Study

Nationwide Screening Practices for Tamoxifen Retinal Toxicity in South Korea: A Population-Based Cohort Study

The effect of systemic and topical ophthalmic medications on choroidal thickness: A review

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