Wall of Fame

Is your case great enough to be selected for our Wall of Fame? If so, we’ll post your name and case here for the world to see!

4/25: Anand Temkar and Manish Nagpal
Tamoxifen retinopathy

3/25: Anand Temkar and Manish Nagpal
Total retinal detachment from giant macular hole

2/25: Vaibhav Sethi
Degenerative retinoschisis

1/25: Anjana Mirajkar and Manish Nagpal
Giant tear retinal detachment

12/24: Sharat Hegde
Diffuse unilateral subacute neuroretinitis (DUSN)

11/24: Anand Temkar and Manish Nagpal
Unilateral anemic retinopathy with optic nerve edema

10/24: Evgenii Chernov
Best disease

9/24: Anjana Mirajkar and Manish Nagpal
Intraocular foreign body

8/24: Anjana Mirajkar and Manish Nagpal
Pseudopapilledema from leukemic optic nerve infiltration

7/24: Justin Grassmeyer, Ambar Faridi, and Brittany Heckerman
Lattice degeneration

6/24: Ogugua Okonkwo, Adekunle Olubola Hassan, Ayodele Harriman, Ogochukwu Sibeudu, and Idris Akintayo Oyekunle
Tuberculous serpiginous-like choroiditis

5/24: Seif Anwar
Inherited retinal disease

Sengül Özdek and Ece Özdemir Zeydanlı
Case of the Year winner!
Retinal Arteriovenous malformation

4/24: Kanwaljeet Harjot Madan
Shaken baby syndrome

3/24: Ayushi Gupta and Vishal Agrawal
Benign familial fleck retina

2/24: Will Gibson
Retinal venous malformation

12/23: Anjana Mirajkar and Manish Nagpal
Central retinal artery occlusion with cilioretinal sparing

11/23: Anjana Mirajkar and Manish Nagpal
Harada’s disease

10/23: Will Gibson
Posterior scleritis with chorioretinal folds

9/23: Shivraj Tagare and Nishant Maindargi
Valsalva retinopathy drained with YAG laser

8/23: Mohammad Abbas
Laser-induced retinal break and vitreous hemorrhage

7/23: Joe Yuenpang Cheung
Group-type congenital pigmented nevi of the RPE (bear tracks)

6/23: Gil Calvão-Santos and Keissy Sousa
Waardenburg Syndrome

5/23: Natasa Draca and Ratko Lazic
Tattoo-induced Uveitis

4/23: Veronika Matello and Barbara Parolini
Case of the Year winner!
The EmPuzzled Eye

3/23: Emma Oreskovic and Natasha Draca
Optic nerve pit

2/23: Anjana Mirajkar
Giant RPE tear

11/22: Veronika Matello and Barbara Parolini
Choroidal hemangioma widefield OCT

8/22: Nivesh Gupta
Ischemic central retinal vein occlusion

7/22: Omar Mulki:
Choroidal osteoma

3/22: Erdem Dinç
Is temporary ILM flap sufficient for MH closure?

1/22: Veronika Matello and Barbara Parolini
Case of the Year winner!
Choroidal transplant for subfoveal AMD MNV

12/21: Otis Hertsenberg
Optic nerve coloboma with pit

11/21: David Kilpatrick
Frosted branch angiitis from sarcoidosis

10/21: Kumar Chugani
Coats disease

Tamoxifen retinopathy

Congratulations to Anand Temkar and Manish Nagpal for submitting the Retina Rocks Case of the Month. This 51YO female presented with 3 months of bilateral vision loss. She was diagnosed 5 years earlier with breast cancer followed by a radical mastectomy. Since then, she has been treated with tamoxifen 20mg PO daily. Vision was 20/60 OD and 20/40 OS. Color photography shows bilateral and symmetric central macular yellowish crystalline deposits (images 1 and 2) which correspond to tiny hyperreflective inner retinal lesions on OCT. Central inner retinal cavitations, outer nuclear layer loss and disruption of the ellipsoid zone and outer segment bands are noted, particularly in the left eye. The prevalence of tamoxifen retinopathy for patients taking tamoxifen 20mg daily may be as high as 12% (Kim et al, Ophthalmology 2020;127:555-557). Although most oncologists do not require this, it is not unreasonable to perform ophthalmic screening examinations with OCT following 2 years of therapy (Tenney et al, Surv Ophthalmology 2023;69:42-50). Tamoxifen inhibits the glutamate-aspartate transporter, leading to excessive intracellular accumulation of glutamate in Müller cells which are vital in maintaining retinal cell integrity and homeostasis. Tamoxifen retinopathy shows very similar findings with macular telangiectasia type 2 (MacTel 2, Lee et al, Ophthalmology Retina 2020;3:681-689), including retinal cavitations, right-angle venules and inner retinal crystals. Both disorders likely share Muller cell injury as a common etiology. The changes in MacTel2 are usually in the temporal fovea, whereas they seem to be more diffusely distributed throughout the central macula with tamoxifen (Hess et al, Retina 2023;7:101-110). Ocular toxicity is more common with a cumulative dose over 100 grams, although our patient still developed classic toxicity despite a cumulative dose of only 35.2 grams. The tamoxifen was discontinued after discussion with the treating oncologist. Three months later the vision and retinal findings were unchanged.

Case of The Month

Tamoxifen retinopathy