Multimodal Imaging in a Severe Case of Hydroxychloroquine Toxicity

• Published in: Ophthalmic surgery, lasers & imaging Vol. 46; no. 3; pp. 377 - 379
• Main Authors: Bhavsar, Kavita V, Mukkamala, Lekha K, Freund, K Bailey
• Format: Journal Article
• Language: English
• Published: United States SLACK INCORPORATED 01.03.2015
• Subjects: Antirheumatic Agents - toxicity; Atrophy; Electroretinography; Female; Fluorescein Angiography; Fluorescence; Humans; Hydroxychloroquine - toxicity; Laser surgery; Lupus Erythematosus, Systemic - drug therapy; Macular Edema - chemically induced; Macular Edema - diagnosis; Macular Edema - physiopathology; Middle Aged; Multimodal Imaging; Ophthalmology; Retinal Diseases - chemically induced; Retinal Diseases - diagnosis; Retinal Diseases - physiopathology; Retinal Pigment Epithelium - drug effects; Retinal Pigment Epithelium - pathology; Tomography, Optical Coherence; Toxicity; Vision Disorders - chemically induced; Vision Disorders - diagnosis; Vision Disorders - physiopathology; Visual Acuity - drug effects; Visual Acuity - physiology; Withholding Treatment
• ISSN: 2325-8160; 2325-8179
• DOI: 10.3928/23258160-20150323-14

Retinal toxicity from hydroxychloroquine (HCQ) can be detected most readily on fundus autofluorescence, spectral-domain optical coherence tomography, and multifocal electroretinogram. The authors describe a case of a 60-year-old woman with a history of systemic lupus erythematosus undergoing HCQ treatment for 30 years who presented with visual loss over several years. Examination and multimodal imaging showed bilateral retinal pigment epithelium (RPE) changes in a bull’s-eye distribution associated with cystoid macular edema. A novel imaging modality, multi-spectral imaging, appeared sensitive in detecting a bull’s-eye pattern of RPE disturbance involving the entire macular region of both eyes. Cessation of drug was advised with close follow-up. [[ Ophthalmic Surg Lasers Imaging Retina . 2015;46:377–379.]