Optical coherence tomography findings in hydroxychloroquine and chloroquine-associated maculopathy

Abstract

Background: Vision loss and maculopathy associated with hydroxychloroquine and chloroquine use are infrequent but significant adverse effects. Bull's eye maculopathy related to these drugs, including peripheral and macular pigment changes, has been described; however, to our knowledge, optical coherence tomography (OCT) findings of the associated retinal pigment epithelium (RPE) atrophy have not yet been reported.

Methods: Single case report.

Results: A 48-year-old woman was treated with hydroxychloroquine (7.8 mg/[kg · d]) for 8 years followed by chloroquine (3.9 mg/[kg · d]) for 5 months for systemic lupus erythematosus. Fundus examinations for toxicity were conducted every 6 months. These medications were discontinued when the patient developed photopsias. Nine years after discontinuation, the patient further developed new scotomas and a bull's eye pattern RPE atrophy. The photographic and OCT findings of hydroxychloroquine- and chloroquine-associated maculopathy are presented along with guidelines on dosing and screening.

Conclusion: The ophthalmologist's awareness of dosing guidelines and communication with prescribing physicians are important in preventing ocular toxicities associated with hydroxychloroquine and chloroquine. Current guidelines suggest the following maximal dosages: hydroxychloroquine, 6.5 mg/(kg · d); and chloroquine, 3 mg/(kg · d). A patient weighing <135 lb should not receive >400 mg of hydroxychloroquine daily.