Case report of advanced chloroquine retinopathy: Do we still miss the bull's eye

Abstract

Chloroquine retinopathy is rarer nowadays due to the availability of its safer alternative hydroxychloroquine for the treatment of autoimmune conditions and due to the revised screening guidelines. We present two cases, one case of an elderly lady and another of a young lady who was on treatment with chloroquine 250 mg/day for rheumatoid arthritis and presented with features of advanced maculopathy. Their fundus examination showed temporal disc pallor with RPE pigment mottling at the parafovea which was later confirmed as bull's eye maculopathy on fundus autofluorescence (FAF). Spectral-domain optical coherence tomography (SD-OCT) showed the absence of the ellipsoid zone (EZ) and external limiting membrane (ELM) along with severe thinning of the ganglion cell layer (GCL) and inner plexiform layer (IPL) at the parafovea in both eyes. An urgent referral letter to the treating physicians regarding the need to switch to a safer alternative medication was made.

Keywords

• chloroquine (cq) retinopathy
• hydroxychloroquine (hcq) retinopathy
• revised screening guidelines for chloroquine/hcq retinopathy (aao 2016)