A CASE REPORT OF TAMOXIFEN-RELATED OCULAR TOXICITY -- BILATERAL ASYMMETRIC OPTIC NEUROPATHY AND CYSTOID MACULAR EDEMA

Tamoxifen之相關眼毒性雙側不對稱眼神經病變併囊狀黃斑部水腫之案例報告

盛少廷(Shao-Ting Sheng) ； 黃啟訓(Chi-Shin Hwang) ； 顏如娟(Ju-Chuan Yen)

《中華民國眼科醫學會雜誌》 53卷2期 (2014/10) Pp. 112-122

https://doi.org/10.30048/ACTASOS.201410_53(2).0003

摘要

目的；服用Tamoxifen 造成雙側不對稱視神經炎及黃斑部囊狀水腫之案例報告。方法：病例報告。結果：一名罹患乳癌75歲女性病患接受Tamoxifen藥物總劑量達8.82公克治療長達一年半。她至眼科門診主述左眼視力模糊已十天，最佳矯正視力右眼為6/15左眼為6/60。眼底檢查下發現左眼視乳突水腫併出血，石原氏色盤檢查右眼為15/15 左眼0/15。眼球前段檢查正常，雙眼皆無相對傳入瞳孔反應異常。視覺誘發電位檢查下左眼反應不良合併右眼振幅減少。光學同調斷層掃描檢查出左眼有明顯的黃斑部囊狀水腫及視神經盤沿體積有顯著增加。視野檢查下雙眼有概括性的緊縮。腦部的電腦斷層掃描及核磁共振掃描檢查並沒有任何惡性轉移。於是諾瓦得士錠立刻停止服用，十週後她的視力逐漸恢復至6/10，色盤檢查也有15/15，同時視神經水腫的部分也消失。光學同調斷層掃描檢查下左眼視神經的體積減少及黃斑部水腫消失。兩個月後追蹤，雙眼視野檢查有局部改善。視覺誘發電位檢查出左眼潛期延長(132ms)併振幅減少(8.7uV)，右眼振幅也有增加。結論；乳癌在台灣這幾年伴隨全球的發生率有明顯的上升，存活率因為創新的賀爾蒙治療法如諾瓦得士錠而增加。諾瓦得士錠的相關眼毒性可能有角膜病變、水晶體病變、視網膜病變，但視神經炎的發生率較少。我們報告此例諾瓦得士錠以雙側不對稱眼神經炎呈現相關眼毒性。

並列摘要

Purpose: To present a case of Tamoxifen-induced ocular toxicity with bilateral asymmetric optic neuritis and cystoid macular edema Method: A case report. Results: A 75-year-old female breast cancer patient had been under Tamoxifen treatment for one and a half years with an accumulated dosage of 8.82 grams. She came to our ophthalmology outpatient department because of blurred vision in the left eye for 10 days. Her best-corrected visual acuity (BCVA) was 6/15 in the right eye and 6/60 in the left eye. Her fundoscopy revealed optic disc swelling and peri-papillary hemorrhage in the left eye. Her color sense of Ishihara color plate was 15/15 in the right eye and 0/15 in the left eye. Her anterior segment examination was normal in both eyes. There was no relative afferent pupillary defect in either eye. Her visual evoked potential (VEP) showed poor response in the left eye and decreased amplitude in the right eye. The optical coherence tomography (OCT) in the left eye showed marked cystoid macular edema and profound increase in optic nerve rim volume. The visual field (VF) examination in both eyes revealed marked generalized constriction. Her brain computed tomography (CT) and magnetic resonance imaging (MRI) revealed no brain metastasis. Tamoxifen was discontinued accordingly and her visual acuity recovered gradually to 6/10. Her color sense redeemed slowly to 15/15 in the left eye in ten weeks, and her optic disc swelling subsided. Her consecutive OCT revealed decreased optic nerve rim volume and subsided cystoid macular edema in the left eye. At two- month follow-up of visual field, partial recovery was found in both eyes. Prolonged latency (132 ms) and decreased amplitude (8.7 uV) in the left eye and increased amplitude in the right eye were noted in VEP examination. Conclusion: The ocular toxicity of Tamoxifen might be keratopthy, lenticulopathy, retinopathy, while optic neuritis is extremely rare and could be sight-threatening. We present a rare case of Tamoxifen-related ocular toxicity of bilateral asymmetric optic neuritis and cystoid macular edema.

並列關鍵字

Tamoxifen ； optic neuritis ； ocular-related toxicity ； breast cancer