title: Retinal damage in chloroquine maculopathy, revealed by high resolution imaging: a case report utilizing adaptive optics scanning laser ophthalmoscopy.
abstract: A 53-year-old Asian woman was treated with hydroxychloroquine and chloroquine for lupus erythematosus. Within a few years, she noticed circle-shaped shadows in her central vision. Upon examination, the patient's visual acuity was 20 / 25 in both eyes. Humphrey visual field (HVF) testing revealed a central visual defect, and fundoscopy showed a ring-shaped area of parafoveal retinal pigment epithelium depigmentation. Fundus autofluorescence imaging showed a hypofluorescent lesion consistent with bull's eye retinopathy. Adaptive optics scanning laser ophthalmoscope (AO-SLO) revealed patch cone mosaic lesions, in which cones were missing or lost. In addition, the remaining cones consisted of asymmetrical shapes and sizes that varied in brightness. Unlike previous studies employing deformable mirrors for wavefront aberration correction, our AO-SLO approach utilized dual liquid crystal on silicon spatial light modulators. Thus, by using AO-SLO, we were able to create a photographic montage consisting of high quality images. Disrupted cone AO-SLO images were matched with visual field test results and functional deficits were associated with a precise location on the montage, which allowed correlation of histological findings with functional changes determined by HVF. We also investigated whether adaptive optics imaging was more sensitive to anatomical changes compared with spectral-domain optical coherence tomography.
authors: Department of Ophthalmology, Kangdong Sacred Heart Hospital, Hallym University Medical Center, Seoul, Korea.
authors: Eun Jin
authors: EJ
authors: Bae
authors: Department of Ophthalmology, Kangdong Sacred Heart Hospital, Hallym University Medical Center, Seoul, Korea.
authors: Kyoung Rae
authors: KR
authors: Kim
authors: Department of Ophthalmology, Columbia University Medical Center, New York, NY, USA.
authors: Stephen H
authors: SH
authors: Tsang
authors: Department of Ophthalmology, Kangdong Sacred Heart Hospital, Hallym University Medical Center, Seoul, Korea. ; Department of Ophthalmology, Columbia University Medical Center, New York, NY, USA.
authors: Sung Pyo
authors: SP
authors: Park
authors: Department of Ophthalmology, Columbia University Medical Center, New York, NY, USA.
authors: Stanley
authors: S
authors: Chang
mesh_terms: D002738:Chloroquine / Q000009:adverse effects* / Q000627:therapeutic use; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007089:Image Enhancement / Q000379:methods*; D008180:Lupus Erythematosus, Systemic / Q000188:drug therapy; D008266:Macula Lutea / Q000187:drug effects / Q000473:pathology*; D008875:Middle Aged; D009887:Ophthalmoscopy / Q000379:methods*; D012164:Retinal Diseases / Q000139:chemically induced / Q000175:diagnosis*
chemical_list: D002738:Chloroquine
keywords: Adaptive optics scanning laser ophthalmoscopy; Bull's eye maculopathy; Chloroquine maculopathy; Hydroxychloroquines; Photoreceptor