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Simone Kellner, Silke Weinitz, Gazaleh Farmand, Ulrich Kellner; Long-term progression, cystoid macular edema and secondary epiretinal membranes in severe chloroquine retinopathy. Invest. Ophthalmol. Vis. Sci. 2013;54(15):5831.
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To investigate the long-term course of chloroquine retinopathy after drug cessation in eyes with marked photoreceptor/retinal pigment epithelial (RPE) damage.
Nine female patients (age range at first examination: 46-78 years) were examined between 1.5 - 6 years after cessation of chloroquine use due to severe retinopathy. In addition to clinical examination they underwent high resolution OCT (SD-OCT; Spectralis OCT, Heidelberg Engineering, Germany), wide-angle fundus and near-infrared autofluorescence (FAF, NIA; HRA2, Heidelberg Engineering, Germany) and wide-angle peripheral fundus autofluorescence (Optos 200Tx; Optos PLC, UK). Follow-up examinations were available in 6/9 patients.
All 9 patients complained about progressive loss of visual function after cessation of the drug (treatment duration: 6-20 years). Progression of retinal degeneration could be documented either by increased changes in FAF, NIA or SD-OCT. FAF and NIA changes included an increase of affected area or a regional increase or decrease of FAF or NIA intensity. SD-OCT changes included reduction of retinal thickness, an increased area of photoreceptor or retinal pigment epithelial loss, development or increase of cystoid macular edema or development of secondary epiretinal membranes. Wide-angle imaging indicated retinal degeneration extended beyond the vascular arcades. Topical or systemic therapy of cystoid macular edema with dorzolamide/acetazolamide was of limited benefit.
Progression of chloroquine retinopathy has to be expected over a long period of time after cessation of drug treatment, and patients need to be counseled accordingly. The course of disease progression may be complicated by cystoid macular edema and epiretinal membrane formation. The present findings underline the necessity for early detection of chloroquine retinopathy.
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