Evidence of Retinal Damage in Chloroquine/Hydroxychloroquine Maculopathy as Revealed by High Resolution Imaging: A Case Report Utilizing Adaptive Optics Scanning Laser Ophthalmoscopy

Abstract

 

Purpose

 

To evaluate structural damage of photoreceptors in a patient with chloroquine/hydroxychloroquine maculopathy and the role of adaptive optics scanning laser ophthalmoscopy in screening of chloroquine/hydroxychloroquine maculopathy

 

Methods

 

A 53-year-old Asian woman who had been treated with hydroxychloroquine and chloroquine for lupus erythematosus, developed bull's eye retinopathy. Humphrey visual field, fundus autofluorescence, and adaptive optics scanning laser ophthalmoscopy were performed. The area with disrupted cone in AO-SLO images were matched with visual field test results.

 

Results

 

Adaptive optics scanning laser ophthalmoscopy (AO-SLO) showed patch cone mosaic lesions, where cones were missing or lost. Additionally, cones that were present were asymmetrical in size and shape and varied in brightness. Disrupted cone AO-SLO images were matched with visual field test results, and functional deficits were given a precise location on the montage. This allowed functional changes (on HVF) to be correlated with histological findings.

 

Conclusions

 

In the present study, bull’s eye maculopathy developed as a result of chronic use of antimalarial agents. The patient was studied with various imaging techniques, including AO-SLO. We demonstrated not only the disrupted microarchitecture of the photoreceptors but also a correlation between functional and structural defects associated with chloroquine retinopathy. The adaptive optics scanning laser ophthalmoscopy will provide better understanding of retinal damages in antimalarial agent-associated retinopathy.

 

 

 

Keywords: 503 drug toxicity/drug effects • 550 imaging/image analysis: clinical • 648 photoreceptors