Optical coherence tomography findings of quinine poisoning

Abstract

Purpose: To report a case of acute quinine poisoning, document acute and chronic macular changes with optical coherence tomography imaging and fluorescein angiography (FA), and to review the literature on ocular toxicity of quinine.

Methods: A 32-year-old white female presented to our Emergency Department after ingesting over 7.5 g of quinine. She underwent a complete ophthalmologic examination, fluorescein angiography, Stratus time-domain optical coherence tomography (OCT), and electroretinography at 72 hours and 15 months postingestion. Stratus time-domain and Cirrus spectral-domain OCT, fundus autofluorescence, and FA were obtained at 28 months postingestion.

Results: Fluorescein angiography at 72 hours postingestion revealed normal filling times and vasculature. OCT showed marked thickening of the inner retina bilaterally. At 15 and 28 months follow-up, fundus photography and fluorescein angiography demonstrated optic nerve pallor, severely attenuated retinal vessels while OCT showed inner retinal atrophy. Fundus autofluorescence did not reveal any retinal pigmentary abnormalities.

Conclusions: Quinine toxicity as seen by OCT reveals increased thickness with inner retinal hyperreflectivity acutely with development of significant retinal atrophy in the long-term. Fundus autofluorescence reveals an intact retinal pigment epithelial layer at 28 months. These findings suggest that quinine poisoning may produce a direct toxic effect on the inner retina in the acute phase resulting in long-term retinal atrophy.

Keywords: optical coherence tomography; quinine toxicity; retinal.

Figure 1

Color fundoscopic images of right a) and left b) eyes 72 hours postingestion demonstrating retinal pallor and cherry red spots. Fluorescein angiograms of right c) and left d) eyes 72 hours postingestion revealing normal retinal vessels.

Figure 2

OCT images of the macula of the right a) and left b) eyes 72 hours postingestion demonstrating marked thickening and hyper-reflectivity of the inner retina. Abbreviations: OCT, optical coherence tomography.

Figure 3

Color fundoscopic images of right a) and left b) eyes 28 months postingestion showing attenuated retinal vessels and optic nerve pallor. FA of the right c) and left d) eyes reveals attenuated vessels without evidence of perfusion deficits. Abbreviations: FA, fluorescein angiography.

Figure 4

Time domain OCT images of the macula of the right a) and left b) eyes 28 months postingestion showing atrophy of the neuroretina. Abbreviations: OCT, optical coherence tomography.

Figure 5

Spectral OCT images of the right a) and left b) eyes 28 months postingestion showing atrophy of the neuroretina. Abbreviations: OCT, optical coherence tomography.

Figure 6

Fundus autofluorescence of right a) and left b) eyes 28 months postingestion demonstrating diffuse hyperfluorescence without evidence of RPE atrophic lesions OU. Abbreviations: RPE, retinal pigment epithelium, OU, both eyes.