Evaluation of hydroxychloroquine retinopathy with multifocal electroretinography.
OBJECTIVE
To describe the changes revealed by multifocal electroretinography (ERG) in patients taking hydroxychloroquine.


METHODS
Six patients being treated for various inflammatory conditions with hydroxychloroquine for periods ranging from 8 months to 7 years were consecutively evaluated. Each examination included measurement of Snellen visual acuities, Amsler grid assessment, and automated visual field testing. In some cases, funduscopic examinations were complimented by photography and fluorescein angiography. Multifocal ERG was performed for all patients.


RESULTS
Three patients (six eyes) were found to have distinctive abnormalities on multifocal ERG consisting of pericentral depression of ERG signals. The abnormalities on multifocal ERG corresponded with the patients' subjective descriptions and the visual field depiction of their pericentral scotomas. All affected patients had been taking hydroxychloroquine for at least 7 years. One patient with generalized depression on multifocal ERG had possible hydroxychloroquine retinopathy. Two patients (three eyes) had relatively normal results on multifocal ERG.


CONCLUSIONS
Multifocal ERG objectively demonstrates depression of signals in the perifoveal region in visually symptomatic patients with long-term hydroxychloroquine use. Even patients with normal visual acuity and no fundus abnormalities can have abnormal results. Although we have not yet identified patients with abnormalities on multifocal ERG before the onset of symptoms, multifocal ERG may be useful in monitoring patients at risk and may provide an earlier opportunity to identify maculopathy.
So
Scott C
SC
University of Texas Southwestern, Dallas, USA.
Hedges
Thomas R
TR
Schuman
Joel S
JS
Quireza
Maria Luz Amaro
ML
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018501:Antirheumatic Agents / Q000009:adverse effects*; D003879:Dermatologic Agents / Q000009:adverse effects; D004596:Electroretinography / Q000379:methods*; D006801:Humans; D006886:Hydroxychloroquine / Q000009:adverse effects*; D008875:Middle Aged; D012160:Retina / Q000187:drug effects* / Q000473:pathology; D012164:Retinal Diseases / Q000139:chemically induced* / Q000175:diagnosis*; D014792:Visual Acuity / Q000187:drug effects; D014794:Visual Fields / Q000187:drug effects
D018501:Antirheumatic Agents; D003879:Dermatologic Agents; D006886:Hydroxychloroquine