The multifocal pattern electroretinogram in chloroquine retinopathy.
OBJECTIVE
Optimal screening for ocular toxicity caused by chloroquine and hydroxychloroquine is still controversial. With the multifocal pattern electroretinogram (mfPERG), a new electrophysiological technique has recently become available to detect early changes of ganglion cells. In this study this new technique is applied to a series of 10 patients seen consecutively receiving long-term chloroquine medication.


METHODS
In 10 patients receiving chloroquine medication, clinical examination, Amsler visual field testing and computerized color vision testing were performed. If toxicity was suspected, automated perimetry was carried out. In addition, in all patients conventional pattern electroretinogram (PERG) and mfPERG testing were performed.


RESULTS
On clinical examination 8 patients showed no chloroquine-associated maculopathy, while 2 patients did. Of these 2, only 1 reported abnormalities when viewing the Amsler chart, while automated perimetry showed typical, ring-like paracentral scotomas in both affected patients and color vision was significantly abnormal. In the normal patients, 4 of 8 had a mild color vision disturbance, which correlated to age-related macular changes. The amplitudes of the PERG and the central (approximately 10 degrees ) responses of the mfPERG were markedly reduced in chloroquine maculopathy, while the latencies were unchanged. The peripheral rings of mfPERG (ranging to 48 degrees ) were not affected by chloroquine toxicity. Both PERG and mfPERG were less affected by age-related macular changes.


CONCLUSIONS
The reduction of PERG and central mfPERG responses in chloroquine maculopathy may help with the early detection of toxicity.
Neubauer
Aljoscha S
AS
Department of Ophthalmology, Ludwig Maximilians University, Munich, Germany. aljoscha.neubauer@med.uni-muenchen.de
Stiefelmeyer
Sandra
S
Berninger
Thomas
T
Arden
Geoffrey B
GB
Rudolph
Günther
G
D000328:Adult; D000368:Aged; D000962:Antimalarials / Q000009:adverse effects*; D002738:Chloroquine / Q000009:adverse effects*; D003119:Color Perception Tests; D003117:Color Vision Defects / Q000139:chemically induced / Q000175:diagnosis; D004596:Electroretinography / Q000187:drug effects* / Q000379:methods; D006801:Humans; D008875:Middle Aged; D012160:Retina / Q000187:drug effects / Q000473:pathology; D012164:Retinal Diseases / Q000139:chemically induced* / Q000175:diagnosis*; D012607:Scotoma / Q000139:chemically induced / Q000175:diagnosis; D015351:Vision Screening / Q000379:methods; D058609:Visual Field Tests; D014794:Visual Fields
D000962:Antimalarials; D002738:Chloroquine