Normalization of generalized retinal function and progression of maculopathy after cessation of therapy in a case of severe hydroxychloroquine retinopathy with 19 years follow-up.
A 40-year-old Caucasian female was first seen 20 years ago for a routine ocular screening in relation to hydroxychloroquine treatment for systemic lupus erythematosus. Her daily dose was 600 mg (or 12 mg/kg of body weight/day) of hydroxychloroquine. Three years later, she complained of mild visual loss in the right eye. Her best-corrected visual acuity was 0.9 in the right (RE) and 1.0 in the left eye (LE). In addition, she had a central scotoma (RE > LE) on automated visual field analysis (Humphrey central 30 degrees ). On fundoscopy and fluorescein angiography, the first signs of a bilateral bull's eye maculopathy were detected. A decreased Arden ratio on EOG (<1.50) was found with an accompanying decreased amplitude of the scotopic b-wave on full-field electroretinography in both eyes. Consequently, the treatment was immediately stopped. During the following years, the patient was retested regularly. After more than 18 years after cessation of the drug, most tests showed a further deterioration, including best-corrected visual acuity (RE: 0.1; LE: 0.7). On visual field testing, a progressive evolution to a total and absolute central scotoma in the RE (central 10 degrees ) and an annular scotoma in the LE became apparent. In contrast, a partial recovery of the Arden ratio of the EOG to 1.8 in both eyes was seen. In addition, a partial recovery of the scotopic b-wave full-field ERG was noted 19 years after cessation of treatment. At retest visits respectively 18, 19 and 20 years after cessation of hydroxychloroquine, a multifocal electroretinogram was performed in combination with colour vision tests and contrast sensitivity measurements.
Salu
Paul
P
Department of Ophthalmology, Universitair Ziekenhuis-Vrij Universiteit Brussel, Laarbeeklaan 101, 1090 Brussels, Belgium. paul.salu@uzbrussel.be
Uvijls
André
A
van den Brande
Pierre
P
Leroy
Bart P
BP
D018501:Antirheumatic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D015350:Contrast Sensitivity / Q000502:physiology; D018450:Disease Progression; D004596:Electroretinography; D005260:Female; D005451:Fluorescein Angiography; D005500:Follow-Up Studies; D006801:Humans; D006886:Hydroxychloroquine / Q000009:adverse effects* / Q000627:therapeutic use; D008180:Lupus Erythematosus, Systemic / Q000188:drug therapy; D008875:Middle Aged; D012160:Retina / Q000187:drug effects / Q000503:physiopathology*; D012164:Retinal Diseases / Q000139:chemically induced* / Q000503:physiopathology*; D012607:Scotoma / Q000503:physiopathology; D014792:Visual Acuity / Q000187:drug effects; D014794:Visual Fields / Q000187:drug effects
D018501:Antirheumatic Agents; D006886:Hydroxychloroquine
Am J Med. 1988 Oct 14;85(4A):23-9
3177429
Doc Ophthalmol. 2006 May;112(3):177-87
16804707
Ophthalmology. 2002 Jul;109(7):1377-82
12093666
Am J Ophthalmol. 2005 Nov;140(5):794-807
16310457
Ophthalmologica. 1969;158 Suppl:592-604
5307973
Chang Gung Med J. 2001 May;24(5):329-34
11480331
Mem Acad R Med Belg. 1964;18:35-327
14218315
Graefes Arch Clin Exp Ophthalmol. 2000 Jan;238(1):94-7
10664060
Ann Ocul (Paris). 1957 Oct;190(10):713-46 contd
13498490
AMA Arch Ophthalmol. 1957 Mar;57(3):451-3
13410231
Ophthalmology. 1999 Sep;106(9):1799-803; discussion 1804
10485553
Eye (Lond). 1989;3 ( Pt 6):777-82
2630362
Doc Ophthalmol. 2009 Feb;118(1):29-36
18465156
Doc Ophthalmol. 2006 Nov;113(3):205-12
17109157
Am J Ophthalmol. 1979 Jul;88(1):1-11
463998
Doc Ophthalmol. 2009 Feb;118(1):69-77
19030905
Am J Med. 1983 Jul 18;75(1A):40-5
6869410
Lancet. 1959 Oct 3;2(7101):478-80
14402143
Doc Ophthalmol. 2005 Jan;110(1):111-20
16249962
Doc Ophthalmol. 2007 Sep;115(2):117-9
17562091
Am J Ophthalmol. 2001 Jun;131(6):761-6
11384574
Curr Eye Res. 2004 Apr;28(4):277-84
15259297
Am J Ophthalmol. 1967 Aug;64(2):245-52
6036279
Can J Ophthalmol. 1992 Aug;27(5):237-9
1393809
Arch Ophthalmol. 1964 Feb;71:157-65
14089382
Br J Ophthalmol. 2003 Jul;87(7):902-8
12812896
Am J Ophthalmol. 2007 May;143(5):801-809
17336914
Acta Ophthalmol (Copenh). 1967;:Suppl 92:1-71
4866642
Doc Ophthalmol. 2008 Jan;116(1):1-11
17972125