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Published in: Graefe's Archive for Clinical and Experimental Ophthalmology 3/2012

01-03-2012 | Retinal Disorders

Comparison of different screening methods for chloroquine/hydroxychloroquine retinopathy: multifocal electroretinography, color vision, perimetry, ophthalmoscopy, and fluorescein angiography

Authors: Susann Mißner, Ulrich Kellner

Published in: Graefe's Archive for Clinical and Experimental Ophthalmology | Issue 3/2012

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Abstract

Purpose

To compare various screening methods for the early diagnosis of retinal dysfunction in patients with long-term chloroquine (CQ) and hydroxychloroquine (HCQ) treatment.

Methods

Twenty patients with long-term CQ/HCQ treatment underwent ophthalmologic evaluation including visual acuity testing, ophthalmoscopy, fluorescein angiography, color vision tests, visual field and multifocal electroretinography (mfERG).

Results

In 14 patients, retinal dysfunction was indicated in the mfERG (reduced amplitudes and/or delayed implicit times) in the parafoveal area. Towards the periphery, the function was normal or only moderately reduced. Ophthalmoscopy and fluorescein angiography identified pathologic retinal changes in seven of these 14 patients. Six patients had normal mfERG, ophthalmoscopy, and fluorescein angiography. Results of color vision and visual field testing were variable even in patients with morphologic alterations.

Conclusion

The use of mfERG may detect retinal dysfunction in a considerable number of eyes with normal ophthalmocopy and fluorescein angiography. The higher variability of color vision and visual field testing results suggests the use of mfERG as primary screening tool for retinal dysfunction in long-term CQ/HCQ treatment.
Literature
1.
2.
go back to reference Shearer RV, Dubois EL (1967) Ocular changes induced by long-term hydroxychloroquine (plaquenil) therapy. Am J Ophthalmol 64:245–252PubMed Shearer RV, Dubois EL (1967) Ocular changes induced by long-term hydroxychloroquine (plaquenil) therapy. Am J Ophthalmol 64:245–252PubMed
3.
go back to reference Bishara SA, Matamoros N (1989) Evaluation of several tests in screening for chloroquine maculopathy. Eye 3:777–782PubMedCrossRef Bishara SA, Matamoros N (1989) Evaluation of several tests in screening for chloroquine maculopathy. Eye 3:777–782PubMedCrossRef
4.
go back to reference American College of Rheumatology Ad Hoc Committee on Clinical Guidelines (1996) Guidelines for monitoring drug therapy in rheumatoid arthritis. Arthritis Rheum 39:723–727CrossRef American College of Rheumatology Ad Hoc Committee on Clinical Guidelines (1996) Guidelines for monitoring drug therapy in rheumatoid arthritis. Arthritis Rheum 39:723–727CrossRef
5.
go back to reference Easterbrook M (1999) Detection and prevention of maculopathy associated with antimalarial agents. Int Ophthalmol Clin 39:49–57PubMedCrossRef Easterbrook M (1999) Detection and prevention of maculopathy associated with antimalarial agents. Int Ophthalmol Clin 39:49–57PubMedCrossRef
6.
go back to reference Alacron GS (2002) How frequently and how soon should we screen our patients for the presence of antimalarial retinopathy? Arthritis Rheum 46:561 Alacron GS (2002) How frequently and how soon should we screen our patients for the presence of antimalarial retinopathy? Arthritis Rheum 46:561
7.
go back to reference Semmer AE, Lee MS, Harrison AR, Olsen TW (2008) Hydroxychloroquine retinopathy screening. Br J Ophthalmol 92:1653–1655PubMedCrossRef Semmer AE, Lee MS, Harrison AR, Olsen TW (2008) Hydroxychloroquine retinopathy screening. Br J Ophthalmol 92:1653–1655PubMedCrossRef
8.
go back to reference Mamor MF, Carr RE, Easterbrook M, Farjo AA, Mieler WF (2002) Recommendations on screening for chloroquine and hydroxychloroquine retinopathy. Opthalmology 109:1377–1382CrossRef Mamor MF, Carr RE, Easterbrook M, Farjo AA, Mieler WF (2002) Recommendations on screening for chloroquine and hydroxychloroquine retinopathy. Opthalmology 109:1377–1382CrossRef
9.
go back to reference Browning DJ (2002) Hydroxychloroquine and chloroquine retinopathy: screening for drug toxicity. Am J Ophthalmol 133:649–656PubMedCrossRef Browning DJ (2002) Hydroxychloroquine and chloroquine retinopathy: screening for drug toxicity. Am J Ophthalmol 133:649–656PubMedCrossRef
10.
go back to reference Warner AE (2001) Early hydroxychloroquine macular toxicity. Arthritis Rheum 4:1959–1961CrossRef Warner AE (2001) Early hydroxychloroquine macular toxicity. Arthritis Rheum 4:1959–1961CrossRef
11.
go back to reference Kellner U, Kraus H, Foerster MH (2000) Multifocal ERG in chloroquine retinopathy: regional variance of retinal dysfunction. Graefes Arch Clin Exp Ophthalmol 238:94–97PubMedCrossRef Kellner U, Kraus H, Foerster MH (2000) Multifocal ERG in chloroquine retinopathy: regional variance of retinal dysfunction. Graefes Arch Clin Exp Ophthalmol 238:94–97PubMedCrossRef
12.
go back to reference So SC, Hedges TR, Schuman JS, Quireza ML (2003) Evaluation of hydroxychloroquine retinopathy with multifocal electroretinography. Ophthalmic Surg Lasers Imaging 34:251–258PubMed So SC, Hedges TR, Schuman JS, Quireza ML (2003) Evaluation of hydroxychloroquine retinopathy with multifocal electroretinography. Ophthalmic Surg Lasers Imaging 34:251–258PubMed
13.
go back to reference Penrose PJ, Tzekov RT, Sutter EE, Fu AD, Allen AW Jr, Fung WE, Oxford KW (2003) Multifocal electroretinography evaluation for early detection of retinal dysfunction in patients taking hydroxychloroquine. Retina 23:503–512PubMedCrossRef Penrose PJ, Tzekov RT, Sutter EE, Fu AD, Allen AW Jr, Fung WE, Oxford KW (2003) Multifocal electroretinography evaluation for early detection of retinal dysfunction in patients taking hydroxychloroquine. Retina 23:503–512PubMedCrossRef
14.
go back to reference Maturi RK, Yu M, Weleber RG (2004) Multifocal electroretinographic evaluation of long-term hydroxychloroquine users. Arch Ophthalmol 122:973–981PubMedCrossRef Maturi RK, Yu M, Weleber RG (2004) Multifocal electroretinographic evaluation of long-term hydroxychloroquine users. Arch Ophthalmol 122:973–981PubMedCrossRef
15.
go back to reference Moschos MN, Moschos MM, Apostolopoulos M, Mallias JA, Bouros C, Theodossiadis GP (2004) Assessing hydroxychloroquine toxicity by the multifocal ERG. Doc Ophthalmol 108:47–53PubMedCrossRef Moschos MN, Moschos MM, Apostolopoulos M, Mallias JA, Bouros C, Theodossiadis GP (2004) Assessing hydroxychloroquine toxicity by the multifocal ERG. Doc Ophthalmol 108:47–53PubMedCrossRef
16.
go back to reference Tzekov RT, Serrato A, Marmor MF (2004) ERG findings in patients using hydroxychloroquine. Doc Ophthalmol 108:87–97PubMedCrossRef Tzekov RT, Serrato A, Marmor MF (2004) ERG findings in patients using hydroxychloroquine. Doc Ophthalmol 108:87–97PubMedCrossRef
17.
go back to reference Lai TY, Chan WM, Li H, Lai RY, Lam DS (2005) Multifocal electroretinographic changes in patients receiving hydroxychloroquine therapy. Am J Ophthalmol 140:794–807PubMedCrossRef Lai TY, Chan WM, Li H, Lai RY, Lam DS (2005) Multifocal electroretinographic changes in patients receiving hydroxychloroquine therapy. Am J Ophthalmol 140:794–807PubMedCrossRef
18.
go back to reference Lai TY, Ngai JW, Chan WM, Lam DS (2006) Visual field and multifocal electroretinography and their correlations in patients on hydroxychloroquine therapy. Doc Ophtalmol 112:177–187CrossRef Lai TY, Ngai JW, Chan WM, Lam DS (2006) Visual field and multifocal electroretinography and their correlations in patients on hydroxychloroquine therapy. Doc Ophtalmol 112:177–187CrossRef
19.
go back to reference Kellner U, Renner AB, Tillack H (2006) Fundus autofluorescence and mfERG for early detection of retinal alterations in patients using chloroquine/hydroxychloroquine. Invest Ophthalmol Vis Sci 47:3531–3538PubMedCrossRef Kellner U, Renner AB, Tillack H (2006) Fundus autofluorescence and mfERG for early detection of retinal alterations in patients using chloroquine/hydroxychloroquine. Invest Ophthalmol Vis Sci 47:3531–3538PubMedCrossRef
20.
go back to reference Lyons JS, Severns ML (2009) Using multifocal ERG ring ratios to detect and follow Plaquenil retinal toxicity: a review: Review of mfERG ring ratios in Plaquenil toxicity. Doc Ophthalmol 118:29–36PubMedCrossRef Lyons JS, Severns ML (2009) Using multifocal ERG ring ratios to detect and follow Plaquenil retinal toxicity: a review: Review of mfERG ring ratios in Plaquenil toxicity. Doc Ophthalmol 118:29–36PubMedCrossRef
21.
go back to reference Marmor MF, Kellner U, Lai TY, Lyons JS, Mieler WF (2011) Revised recommendations on screening for chloroquine and hydroxychloroquine retinopathy. Ophthalmology 118:415–422PubMedCrossRef Marmor MF, Kellner U, Lai TY, Lyons JS, Mieler WF (2011) Revised recommendations on screening for chloroquine and hydroxychloroquine retinopathy. Ophthalmology 118:415–422PubMedCrossRef
22.
go back to reference Kellner U, Kleine-Hartlage P, Foerster MH (1992) Cone dystrophies: clinical and electrophysiological findings. German J Ophthalmol 1:105–109 Kellner U, Kleine-Hartlage P, Foerster MH (1992) Cone dystrophies: clinical and electrophysiological findings. German J Ophthalmol 1:105–109
23.
go back to reference Marmor MF, Hood DC, Keating D, Kondo M, Seeliger MW, Miyake Y (2003) Guidelines for basic multifocal electroretinography (mfERG) (for the International Society for Clinical Electrophysiology of Vision). Doc Ophthalmol 106:105–115PubMedCrossRef Marmor MF, Hood DC, Keating D, Kondo M, Seeliger MW, Miyake Y (2003) Guidelines for basic multifocal electroretinography (mfERG) (for the International Society for Clinical Electrophysiology of Vision). Doc Ophthalmol 106:105–115PubMedCrossRef
24.
go back to reference Polyak SL (1941) The retina. University of Chicago Press, Chicago Polyak SL (1941) The retina. University of Chicago Press, Chicago
25.
go back to reference Hood DC, Seiple W, Holopigian K, Greenstein V, Carr RE (1997) A comparison of components of multi-focal and full-field ERGs. Vis Neurosci 14:533–544PubMedCrossRef Hood DC, Seiple W, Holopigian K, Greenstein V, Carr RE (1997) A comparison of components of multi-focal and full-field ERGs. Vis Neurosci 14:533–544PubMedCrossRef
26.
go back to reference Bernstein HN, Ginsberg J (1964) The pathology of chloroquine retinopathy. Arch Ophthalmol 71:238–245PubMedCrossRef Bernstein HN, Ginsberg J (1964) The pathology of chloroquine retinopathy. Arch Ophthalmol 71:238–245PubMedCrossRef
27.
go back to reference Rosenthal AR, Kolb H, Bergsma D, Huxsoll D, Hopkins JL (1978) Chloroquine retinopathy in the rhesus monkey. Invest Ophthalmol Vis Sci 17:1158–1175PubMed Rosenthal AR, Kolb H, Bergsma D, Huxsoll D, Hopkins JL (1978) Chloroquine retinopathy in the rhesus monkey. Invest Ophthalmol Vis Sci 17:1158–1175PubMed
28.
go back to reference Wetterholm DH, Winter FC (1964) Histopathology of chloroquine retinal toxicity. Arch Ophthalmol 71:82–87PubMedCrossRef Wetterholm DH, Winter FC (1964) Histopathology of chloroquine retinal toxicity. Arch Ophthalmol 71:82–87PubMedCrossRef
29.
go back to reference Shroyer NF, Lewis RA, Lupski JR (2001) Analysis of the ABCR (ABCA4) gene in 4-aminoquinoline retinopathy: is retinal toxicity by chloroquine and hydroxychloroquine related to Stargardt disease? Am J Ophthalmol 131:761–766PubMedCrossRef Shroyer NF, Lewis RA, Lupski JR (2001) Analysis of the ABCR (ABCA4) gene in 4-aminoquinoline retinopathy: is retinal toxicity by chloroquine and hydroxychloroquine related to Stargardt disease? Am J Ophthalmol 131:761–766PubMedCrossRef
30.
go back to reference Mahon GJ, Anderson HR, Gardiner TA, McFarlane S, Archer DB, Stitt AW (2004) Chloroquine causes lysosomal dysfunction in neural retina and RPE: implications for retinopathy. Curr Eye Res 28:277–284PubMedCrossRef Mahon GJ, Anderson HR, Gardiner TA, McFarlane S, Archer DB, Stitt AW (2004) Chloroquine causes lysosomal dysfunction in neural retina and RPE: implications for retinopathy. Curr Eye Res 28:277–284PubMedCrossRef
31.
go back to reference Bienfang D, Coblyn JS, Liang MH, Corzillius M (2000) Hydroxychloroquine retinopathy despite regular ophthalmologic evaluation: a consecutive series. J Rheumatol 27:2703–2706PubMed Bienfang D, Coblyn JS, Liang MH, Corzillius M (2000) Hydroxychloroquine retinopathy despite regular ophthalmologic evaluation: a consecutive series. J Rheumatol 27:2703–2706PubMed
32.
go back to reference Rüther K, Foerster J, Berndt S, Schroeter J (2007) Variabilitat der retinotoxischen Gesamtdosis Chloroquin/Hydroxychloroquin. Ophthalmologe 104:875–887PubMedCrossRef Rüther K, Foerster J, Berndt S, Schroeter J (2007) Variabilitat der retinotoxischen Gesamtdosis Chloroquin/Hydroxychloroquin. Ophthalmologe 104:875–887PubMedCrossRef
33.
go back to reference Rodriguez-Padilla JA, Hedges TR 3rd, Monson B, Srinivasan V, Wojtkowski M, Reichel E, Duker JS, Schuman JS, Fujimoto JG (2007) High-speed ultra-high-resolution optical coherence tomography findings in hydroxychloroquine retinopathy. Arch Ophthalmol 125:775–780PubMedCrossRef Rodriguez-Padilla JA, Hedges TR 3rd, Monson B, Srinivasan V, Wojtkowski M, Reichel E, Duker JS, Schuman JS, Fujimoto JG (2007) High-speed ultra-high-resolution optical coherence tomography findings in hydroxychloroquine retinopathy. Arch Ophthalmol 125:775–780PubMedCrossRef
34.
go back to reference Kellner S, Weinitz S, Kellner U (2009) Spectral domain optical coherence tomography detects early stages of chloroquine retinopathy similar to multifocal electroretinography, fundus autofluorescence and near-infrared autofluorescence. Br J Ophthalmol 93:1444–1447PubMedCrossRef Kellner S, Weinitz S, Kellner U (2009) Spectral domain optical coherence tomography detects early stages of chloroquine retinopathy similar to multifocal electroretinography, fundus autofluorescence and near-infrared autofluorescence. Br J Ophthalmol 93:1444–1447PubMedCrossRef
Metadata
Title
Comparison of different screening methods for chloroquine/hydroxychloroquine retinopathy: multifocal electroretinography, color vision, perimetry, ophthalmoscopy, and fluorescein angiography
Authors
Susann Mißner
Ulrich Kellner
Publication date
01-03-2012
Publisher
Springer-Verlag
Published in
Graefe's Archive for Clinical and Experimental Ophthalmology / Issue 3/2012
Print ISSN: 0721-832X
Electronic ISSN: 1435-702X
DOI
https://doi.org/10.1007/s00417-011-1753-2

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