Title

MULTIMODAL EVALUATION OF THE RETINA IN TOXIC MACULOPATHY DUE TO ANTIMALARIAL DRUG

Introduction

The use of antimalarial drugs, such as hydroxychloroquine, for the treatment of autoimmune diseases is not uncommon among rheumatologists and dermatologists. Despite the low risk, prolonged use of these medications can result in damage to the photoreceptors and pigmented retinal epithelium, an event known as toxic retinopathy. Advanced cases of this retinopathy can lead to irreversible loss of vision and, for this reason, periodic screening tests are mandatory for these patients.

Methods

A case report with medical record review.

Results

75 yo male, comes for ophthalmologic consultation without any complaints. He refers to the use of Hydroxychloroquine for the treatment of Lichen Planus for a long time. Examination of both eyes (BE) showed the best corrected visual acuity of 20/40, biomicroscopy and tonometry were unremarkable in BE. Fundoscopy revealed mild macular hypochromic alteration, concentric to the fovea, in BE. The multimodal evaluation of the retina performed highlighted the alteration previously seen in fundoscopy. The patient was advised to make a new appointment with the Dermatologist and discontinue the use of the medication.

Discussion

Retinal toxicity due to antimalarials is a serious condition as it can cause irreversible visual loss when the diagnosis is postponed. Proper screening has the potential to prevent the occurrence of advanced forms of the disease. The different scans performed with the SD-OCT can be analyzed objectively and subjectively. The B-scan is the most widespread image and presents more information to the ophthalmologist. Mild changes in the outer layers of the retina are the initial changes in the disease. In the final stages there is atrophy of the entire external retina in the macular region. In this case, in addition to the fundscopic finding, autofluorescence, SD-OCT and computerized campimetry showed changes compatible with toxic maculopathy (bull’s eye).

Keywords

bull's eye; maculopathy; hydroxychloroquine; multimodal.

Area

CLINICAL CASE

Authors

Rafael Cicconi Arantes, Lana Martins Menezes, Juliana Abreu Rio, Ricardo Luz Leitão Guerra