PMC7434374_01
Fundus photograph of left eyes (A) demonstrating macular pigmentary changes with diffuse tiny yellow crystals (yellow arrow) and reduced macular tessellation. The fundus photography of the left eye (B) shows fewer changes.
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Fundus autofluorescence of right eye (A) reveals stippled hypo and hyper autofluorescence areas that are more prominent in the macular area accompanying with patchy hyper autofluorescence area inferior to the fovea. There are no significant changes in the autofluorescence picture of the left eye (B). Infrared reflectance (IR) images reveal irregular hyperreflective and hyporeflective lesions bilaterally especially in the right eye (C and D). On Spectral-domain optical coherence tomography (SD-OCT) there is retinal pigment epithelium (RPE) abnormality and ellipsoid zone discontinuity accompanying with retinal thinning that is more prominent in the right eye. The expansion of Haller's layer is detectable exactly beneath the lesions (E and F). Fluorescein angiography (FA) of the right eye reveals a punctuated hyperfluorescent patch in the central macular area without obvious leakage (G and I). There is some blocking area in the FA of the left eye due to vitreous organizations (H and J).
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There was no significant change in autofluorescence pictures of the left eye (Figure 2). Fluorescein angiography (FA) of the right eye revealed a punctuated hyperfluorescent patch in the central macular area without obvious leakage (Figure 2).
Optical coherence tomography (OCT) of the fovea, demonstrates significant retinal thinning in the right eye (A) compared to the left eye (B). Three months after the first visit, the patient still was under treatment with oral Tamoxifen. Fovea OCT revealed the progression of retinal pigment epithelium (RPE) abnormality and ellipsoid zone discontinuity. The changes were more detectable in the right eye (C and D). One year after Tamoxifen discontinuation, SD-OCT revealed some surprising recoveries in the photoreceptor layers especially in the right eye (E and F). The mentioned changes were consistent with the patient's visual acuity improvement.
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Three months after the first visit, she still was under treatment with oral Tamoxifen surprisingly. Patient BCVA was considerably deteriorated in both eyes (right eye:20/200 and left eye:20/30). The EDI-OCT revealed the progression of the ellipsoid zone disruption in the right eye (Figure 3). Evaluation with SD-OCT revealed some surprising recoveries in the photoreceptor layers, especially in her right eye (Figure 3).