Título

RETINAL MULTIMODAL EVALUATION IN ANTIMALARIAL TOXIC MACULOPATHY

Objetivo

To describe a hydroxychloroquine-induced toxic maculopathy in a asymptomatic 75-year-old male patient that referred to use Hydroxychloroquine for the treatment of Lichen Planus for a long time

Métodos

case report

Resultados

Hypochromic macular alteration concentric to the fovea in both eyes were found. The multimodal retinal assessment performed included Color Retinography, Autofluorescence (AF), SD-OCT and Computerized Macula Campimetry. The results were compatible with hydroxychloroquine-induced toxic maculopathy and the patient was advised to discontinue the use of the medication

Discussão e Conclusões

Retinal toxicity from antimalarials is a serious condition as it can cause irreversible visual loss. Screening has the potential to prevent the occurrence of advanced forms of the disease. The American Academy of Ophthalmology recommends ophthalmologic evaluation at the beginning of treatment and annual reevaluation, which comprises: Computerized Visual Field, SD-OCT, Multifocal Electroretinogram and AF. The computerized visual field of the macular region allows the assessment of macular function and may present absolute and/or relative scotomas. The B-scan is the most widespread image and presents the most information to the ophthalmologist. Mild changes in the outer layers of the retina are the initial changes in the disease. In final stages, atrophy of the entire outer retina in the macular region occurs.
Through C-Scan, SD-OCT also allows topographic, volumetric and en-face retinal imaging. These analyzes are extremely useful to aid in early diagnosis and follow-up. AF objectively presents the viability and function of the retinal pigment epithelium. In hydroxychloroquine toxic maculopathy, initial changes appear as parafoveal hyperautofluorescent areas, while advanced lesions appear hypoautofluorescent. In the present case, in addition to the funduscopic finding, autofluorescence, SD-OCT and computerized perimetry showed alterations compatible with toxic maculopathy (target lesion)

Palavras Chave

hydroxychloroquine-induced toxic maculopathy

Área

Clínica