J Korean Ophthalmol Soc.  2012 Sep;53(9):1357-1363. 10.3341/jkos.2012.53.9.1357.

A Case of Hydroxychloroquine Retinopathy

• Lee JJ
• Baek SK
• Lee TG
• Yoo SJ

• KMID: 2216093
• DOI: http://doi.org/10.3341/jkos.2012.53.9.1357

Abstract

PURPOSE
Hydroxychloroquine has been used as the antimalarial agent and drug of the treatment for autoimmune disease such as rheumatoid arthritis. Hydroxychloroquine retinopathy can cause serious visual disturbance although the incidence is low. This report is to describe a case of Hydroxycholoroquine retinopathy on 73 year old female.
CASE SUMMARY
A 73 year old female patient presented our clinic with complaints of visual disturbance for several months. She had taking 400 mg/day (8.8 mg/kg of lean body weight/day) of hydroxychloroquine for 2 years. The best corrected visual acuity was 20/30 in both eyes. Bull's eye maculopathy was observed on her fundus examination and Humphrey Automated Visual Field 24-2 showed central scotoma in both eyes. Parafoveal thinning of photoreceptor layers, loss of the inner and outer segment junction and external limiting membrane was observed on spectral domain Optical Coherence Tomography. Window defect was visible at the parafoveal area on fluorescein angiography. Electroretinogram revealed subtle dysfunction of cone cell and multifocal ERG trace array showed decreased amplitudes at the parafoveal area. Electrooculogram showed decreased Arden ratio.
CONCLUSIONS
We strongly advise that all patients taking Hydorxycholoroquine therapy have a regular examination to find hydroxychloroquine retinopathy in early stage especially in the patients having high risk factors.

Keyword

Bull's eye maculopathy; Hydroxychloroquine; Rheumatoid arthritis

MeSH Terms

Arthritis, Rheumatoid
Autoimmune Diseases
Electrooculography
Eye
Female
Fluorescein Angiography
Humans
Hydroxychloroquine
Incidence
Membranes
Risk Factors
Scotoma
Tomography, Optical Coherence
Visual Acuity
Visual Fields
Hydroxychloroquine

Figure

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  Figure 1 Fundus photograph shows diffuse RPE atrophy of macula with foveal sparing in both eyes. (A) Right eye. (B) Left eye.

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  Figure 2 Humphrey Automated Visual Field 24-2 shows central scotoma in both eyes.

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  Figure 3 Spectral domain-OCT shows parafoveal thinning of photoreceptor layers and loss of the inner and outer segment junction line (white arrows).

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  Figure 4 Fluorescein Angiography shows window defect at parafoveal area (Bull's eye maculopathy). (A) Right eye. (B) Left eye.

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  Figure 5 Electroretinogram reveals subtle dysfunction of cone cell.

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  Figure 6 Multifocal ERG trace array shows decreased amplitudes in parafoveal area.

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  Figure 7 Electrooculogram shows decreased Arden ratio.

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