Chloroquine
- PDF / 170,769 Bytes
- 1 Pages / 595.245 x 841.846 pts (A4) Page_size
- 38 Downloads / 155 Views
1 S
Bull’s eye maculopathy: case report A woman in her 50s [exact age at reaction onset not stated] developed Bull’s eye maculopathy during treatment with chloroquine for systemic lupus erythematosus [SLE; route and time to reaction onset not stated]. The woman presented for second opinion for treatment of progressive visual impairment secondary to chloroquine maculopathy. She had received chloroquine-diphosphate [Resochin; chloroquine phosphate] 2.5mg/day (3.9 mg/kg/day, equivalent to 2.9 mg/kg chloroquine) for SLE for 13 years. This corresponded to a cumulative dose of 1186g (equivalent to 882g of chloroquine). She had developed central visual field defect, fundoscopic pigment epithelial transfers and perifoveal loss of the outer segments seen in the optical coherence tomography. Therefore, in the thirteenth year of the therapy, chloroquine had been switched to methotrexate alternating with folic acid. At that time, the woman had visual acuity 1.0/0.8cc, and desaturated Farnsworth D-15 panel had shown errors in the tritan axis. After cessation of chloroquine, she had been visiting the eye clinic every 6 months. She had exhibited decrease in the perifoveal retinal thickness. Additionally, she had central visual field defects and colour confusion, and a visual acuity reduced to 0.5/0.4cc. Six years after cessation of chloroquine (at the current presentation), she had bilateral visual acuity of 0.3cc, with an extended range of vision of 15mm Hg bilaterally. Funduscopic examination showed a Bull’s eye maculopathy, and autofluorescence with pericentral reduction of autofluorescence with surrounding hyperautofluorescent ring. Optical coherence tomography (OCT) showed perifoveal loss of the outer segments and the retinal pigment epithelium. This appeared to have increased as compared to the previous image. The central visual field defect was noted to be significantly increased over time. The multifocal electroretinogram, which was performed for the first time, showed a decrease in amplitude on both sides in rings 1 and 2. The choriocapillaris was mildly defected on the left eye as seen with OCT angiography. No relative afferent pupillary defect was noted. Additionally, a known stable choroidal keratitis on the temporal upper vessel in the superior arcade of the right eye was observed. She was prescribed vitamin-D3 and doxepin. She was informed about the lack of therapeutic options for the chloroquine related maculopathy, and regular check up every 6 months was recommended. Cessation of chloroquine was not expected to result in improvement of the symptoms. Rickmann A, et al. [Progressive maculopathy despite discontinuation of chloroquine treatment-multimodal imaging and review of the literature]. [Review] Ophthalmologe 117: 803518864 917-925, No. 9, Sep 2020. Available from: URL: http://doi.org/10.1007/s00347-019-00994-6 [German; summarised from a translation]
0114-9954/20/1833-0001/$14.95 Adis © 2020 Springer Nature Switzerland AG. All rights reserved
Reactions 5 Dec 2020 No. 1833
Data Loading...
