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S. Kellner, S. Weinitz, U. Kellner; Retinal Changes in Long-Term Chloroquine Treatment: Lipofuscin- and Melanin-Related Fundus Autofluorescence, OCT and Multifocal ERG. Invest. Ophthalmol. Vis. Sci. 2008;49(13):2169.
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To evaluate melanin-related near-infrared fundus autofluorescence (NIA, excitation 787 nm, emission > 800 nm), lipofuscin-related fundus autofluorescence (FAF, excitation 488 nm, emission > 500 nm), optical coherence tomography (OCT) and multifocal electroretinography (mfERG) in patients with long-term chloroquine (CQ) treatment.
Five female patients with CQ treatment (5-20 years) underwent clinical examination, ISCEV mfERG evaluation, OCT3 imaging, and FAF/NIA imaging using a confocal SLO (Heidelberg Retina Angiograph 2) with either a 30 degree or wide-angle field-of-view.
In patient 1 (age 31 years, 16 y. CQ, estimated cumulative dose: 1460 g) all four examinations were completely normal. Patient 2 (60 y., 14 y. CQ, eCD: 1278 g) with normal FAF and mfERG at age 58 y., developed paracentral mfERG amplitude reduction and corresponding FAF and NIA alterations as well as reduced parafoveal retinal thickness in the OCT. She had noted only mild reading problems. Visual acuity and ophthalmoscopy were normal. Patient 3 (51 y., 5 y. CQ, eCD: 456 g) developed visual loss, central and paracentral scotoma, mfERG amplitude reduction and reduced retinal thickness (OCT) as well as marked pericentral FAF and NIA alterations and paravascular increased FAF. In patients 4 & 5 (46 y., 10 y. CQ, eCD: 912 g; 51 y., 20 y. CQ, eCD: 1825 g) with progressed CQ retinopathy FAF and NIA were relatively normal in the foveola, associated with preserved single letter acuity. Parafoveal loss of RPE was indicated by absent FAF and NIA. An area of reduced FAF and NIA surrounded the parafoveal region of RPE loss. In the adjacent area, FAF was increased, and increased NIA marked the peripheral border of increased FAF. Wide-field imaging revealed increased FAF in association with retinal vessels. Retinal thickness was markedly reduced in the OCT predominantly in the parafoveal region. Visual field loss and mfERG amplitude reduction corresponded to areas with increased or reduced FAF and NIA. Except for the age, there was no obvious difference in the patient’s general history that could explain the difference of retinal damage.
Long-term CQ treatment is often, but not necessarily associated with CQ retinopathy. FAF, NIA, OCT and mfERG allow to detect early stages of CQ retinopathy and provide further insights in the pathogenesis and development of CQ retinopathy. An association of CQ retinopathy with retinal vessels architecture is hypothesized.
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