Hydroxychloroquine and chloroquine retinopathy: screening for drug toxicity1
Section snippets
Design
This study is a retrospective observational case series.
Methods
The patients come from a single retina practice. There is no medical school within a 100-mile radius tending to exclude the possibility of overlap in experience with university-based reports. The six comprise all patients with this disorder seen by the author between July 1, 1986 and December 5, 2001. The diagnosis of advanced hydroxychloroquine or chloroquine retinopathy was made based on the combined presence of parafoveal retinal pigment epithelial atrophy as seen on fundus biomicroscopy and
Results
Six cases of advanced hydroxychloroquine and chloroquine retinopathy were diagnosed during a 15-year interval; one in a patient taking chloroquine and five in patients on hydroxychloroquine. The daily dose divided by body mass, the duration of therapy, and the cumulative dose are listed in Table 1. Fundus photographic documentation of toxic retinopathy for five cases is shown in Figure 1, Figure 2, Figure 3, Figure 4, Figure 5 and progression of visual field changes while under monitoring in
Case 3
:A 48-year-old 130-pound Caucasian female was prescribed higher than recommended doses of hydroxychloroquine (Table 1) for her rheumatoid arthritis from 1980 until June 26, 1993, when it was stopped, because of lack of rheumatologic efficacy. She had visual acuity checks, funduscopy, and visual field testing by her ophthalmologist every 6 months. The appropriateness of the patient’s dosage was not questioned throughout this interval. Her visual field was normal in 1989 and 1990 Figure 6, Figure
Discussion
Hydroxychloroquine and chloroquine retinal toxicity begins as paracentral scotomata, which are detectable by threshold visual field testing before any fundus changes are seen. If the toxic drug is stopped before fundus changes occur, the scotomata can resolve though they may not. If the drug is not stopped, parafoveal retinal pigment epithelial atrophic lesions usually develop next and, later, peripheral retinal pigment epithelial mottling occurs. Very advanced changes include arteriolar
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InternetAdvance publication at ajo.com April 24, 2002.