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Impressum
Primary open angle glaucoma and Tamoxifen therapy
Krist D., Harazny J., Michelson G.
Augenklinik mit Poliklinik der Universität Erlangen-Nürnberg, Schwabachanlage 6, D-91054 Erlangen
Background: Tamoxifen interfires with the binding of estradiol
to its target tissues. Ocular toxicity has been well described in patients
with high-dose (40-240 mg per day) as well as in low dose tamoxifen (20
mg ). Besides a Tamoxifen retinopathy/ keratopathy , a thrombotic angiopathy
of the retina was described. Therefore we examined the microcirculation
of the retina under tamoxifen therapy in glaucoma patients.
Patients and methods: Among 128 woman of the "Erlangen glaucoma
registry" using an exploratory questionnaire 2 patients had low-dose
Tamoxifen therapy (20mg per day over 4 years, 30 mg over 5 years). None
of them suffered from additional eye or systemic disease. Microperfusion
of the retina (measured by Scanning laser Doppler flowmetry), intraocular
pressure, visual field defect (Octopus G1) and morphological classification
was registered during tamoxifen application.
Results: The juxtapapillary retinal capillary blood flow measured
by scanning laser Doppler flowmetry was with R: 86,4-158,5; T: 152,7-182,8
und N: 94,3-153,9 significantly decreased (normal range: R: 300- 470;T:240-400;
N:240-370) compared to glaucoma patients without tamoxifen therapy. Maximal
intraocular pressure measured 24 respectively 30 mmHg. Morphological classification
resulted in 3 eyes with beginning optic disc cupping and 1 without glaucomatous
damage. A corresponding visual field defect could observed in 1 glaucomatous
eye. Despite tamoxifen intake morphological and functional glaucoma as
well as general ocular findings remain unchanged.
Conclusion: Tamoxifen interfires with the binding of estradiol,
which reduce vascular resistance by enhancing prostaglandin I2 release
and by blunting endothelin 1 production in the vascular endothelium. The
decreased papillary microperfusion might related to such a additional
vascular factor and woman should have a thorough baseline ophthalmic and
rheologic evaluation during tamoxifen therapy.