A Case of Bilateral Branch Retinal Vein Occlusion after Taking Tamoxifen

Jeffrey Lee; Myeong In Yeom; Chang Kyu Lee; Jung Min Park

doi:10.3341/JKOS.2016.57.11.1806

Journal List > J Korean Ophthalmol Soc > v.57(11) > 1010463

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Lee, Yeom, Lee, and Park: A Case of Bilateral Branch Retinal Vein Occlusion after Taking Tamoxifen

Case Report

J Korean Ophthalmol Soc 2016;57(11):1806-1811.

Published online: 25 September 2016

DOI: https://doi.org/10.3341/JKOS.2016.57.11.1806

A Case of Bilateral Branch Retinal Vein Occlusion after Taking Tamoxifen

Jeffrey Lee, MD¹, Myeong In Yeom, MD¹, Chang Kyu Lee, MD², Jung Min Park, MD, PhD¹

¹Department of Ophthalmology, Maryknoll Medical Center, Busan, Korea

²Department of Ophthalmology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea

Address reprint requests to Jung Min Park, MD, PhD Department of Ophthalmology, Maryknoll Medical Center, #121 Junggu-ro, Jung-gu, Busan 48972, Korea Tel: 82-51-461-2540, Fax: 82-51-462-3534 E-mail: pjm1438@hanmail.net

Received 16 June 2016 Revised 22 August 2016 Accepted 20 October 2016

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To report a case of bilateral branch retinal vein occlusion development after taking long-term tamoxifen adjuvant therapy.

Case summary

A 72-year-old female breast cancer patient with a 10-year history of tamoxifen intake presented with decreased visual acuity that began 5 years prior. The patient had no other past history. The best corrected visual acuity (BCVA) was 0.3 in the right eye and 0.04 in the left eye. There was no specific finding of anterior segment on slit lamp examination. On fundus examination, sheathed branch retinal veins were observed in the inferotemporal area of the right eye and superotemporal and inferotemporal areas of the left eye. Microangiopathies were observed around the occluded branch retinal veins in both eyes and macular edema was present in the left eye. Laser photocoagulation was performed at the non-perfusion area in both eyes and an intravitreal injection of bevacizumab and 3 intravitreal injections of triamcinolone were administered into the left eye. The BCVA did not change after 3 years and remained relatively stable.

Conclusions

If a patient presents with decreased visual acuity after taking tamoxifen, fundus examination and fluorescein angiogram should be performed due to the possibility of branch retinal vein occlusion.

Keywords: Bilateral branch retinal vein occlusion, Breast cancer, Tamoxifen

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Figure 1.

Color fundus photopgraphs of the both eyes. (A) Color fundus photography of the right eye showing sheathed retinal vessel in inferotemporal area with old laser scars. Hyperreflective crystalline dot-like deposits at superior perifoveal area were seen. (B) Color fundus photography of the left eye demonstrating sheathed retinal vessels with old laser scars in superotemporal and inferotemporal area.

Figure 2.

Fluorescein angiogram of the both eyes. (A) Early venous phase fluorescein angiogram of the right eye showing lack of perfusion (arrowhead) in inferotemporal second branch retinal vein. (B) Early venous phase fluorescein angiogram of the left eye showing occlusions (arrowheads) in superotemporal second brach and inferotemporal first brach retinal vein. Late venous phase fluorescein angiogram of the right eye (C), and left eye showing non-perfusion area in inferotemporal regions in the left eye (D). Late phase fluorescein angiogram of the right eye (E) and left eye (F) demonstrating fluorescein leakage.

Figure 3.

Optical coherence tomographs of the both eyes. Optical coherence tomography showing retinal cysts on temporal parafoveal area with retinal atrophy in the right eye (A) and cystoids macular edema in the left eye (B).

Figure 4.

Optical coherece tomographs and venous phase fluorescein angiogram of the both eyes 3 years after the first visit. Optical coherence tomography demonstrating retinal atrophy on temporal macula of the right eye (A), and cystoid macular edema in the left eye (B). Venous phase fluorescein angiogram of the right eye (C) and left eye (D) showing non-perfusion area in both eyes.

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