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LETTER TO THE EDITOR
Year : 2009  |  Volume : 57  |  Issue : 4  |  Page : 327-328

Optical coherence tomography in a patient with chloroquine-induced maculopathy


Shivam Eye Clinic and Surgical Centre, Snehal Co-Op Housing Society, Plot No 29, Sector 17, Nerul, Navi Mumbai - 400 706, Maharashtra, India

Date of Web Publication30-Jun-2009

Correspondence Address:
Suresh Ramchandani
Shivam Eye Clinic and Surgical Centre, Snehal Co-Op Housing Society, Plot No 29, Sector 17, Nerul, Navi Mumbai - 400 706, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


Read associated Letter to the Editor: Authors' reply with this article

DOI: 10.4103/0301-4738.53071

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How to cite this article:
Ramchandani S, Ramchandani S. Optical coherence tomography in a patient with chloroquine-induced maculopathy. Indian J Ophthalmol 2009;57:327-8

How to cite this URL:
Ramchandani S, Ramchandani S. Optical coherence tomography in a patient with chloroquine-induced maculopathy. Indian J Ophthalmol [serial online] 2009 [cited 2020 Feb 17];57:327-8. Available from: http://www.ijo.in/text.asp?2009/57/4/327/53071

Dear Editor,

We read with interest the article 'Optical coherence tomography (OCT) in a patient with chloroquine- induced maculopathy' by Korah et al . [1]

We must congratulate the authors for the excellent article but we would like to make a few points.

  1. Why was the patient started on chloroquine rather that hydroxychloroquine? It is well-documented that hydroxychloroquine has a lower incidence of eye complications compared to chloroquine. [2]
  2. Was the patient regular about her follow-up schedules? What were the findings in the examination done just before the complications were noted? Did the patient have any corneal deposits? Corneal deposits though innocuous are the most commonly described ophthalmological findings following chloroquine therapy. [2] Was a visual field examination done at that time? Were there any retinal pigment epithelium (RPE) alterations? What was the protocol for taking fundus pictures and /or visual field examinations?
  3. Examination and perimetry reliably showed chloroquine toxicity and yet the patient was not told to stop chloroquine but the drug was changed to hydroxychloroquine. Hydroxychloroquine was stopped and methrotrexate started after four months when the patient complained of subjective symptoms. In our opinion chloroquine/hydroxychloroquine should have been stopped earlier.
  4. Any proposed screening test needs to detect retinal lesions at a stage where intervention can reverse the condition or prevent deterioration. If the cases of retinopathy detected by monitoring fail to respond to cessation of therapy, the monitoring does not have a useful role. [3]

    In this case the optical coherence tomography (OCT) findings of significant thinning were seen in a patient who had well-documented changes on fundus examination and perimetry examination. It would be interesting to know if the thinning occurs before any other change can be noted on regular examination. If not, OCT has no role whatsoever.
  5. Multifocal ERG (mfERG) is a very sensitive test for detection of early retinal abnormalities under chloroquine/hydroxychloroquine therapy. Multifocal ERG can reliably detect retinal functional loss associated with chloroquine/hydroxychloroquine retinopathy. In some patients the mfERG showed reduced response amplitudes when other functional tests or morphologic examinations were conducted. In addition, follow-up studies demonstrated a decline of retinal function when using hydroxychloroquine and improvement of retinal function after discontinuation of treatment. [4] In our opinion, an mfERG would diagnose hydroxychloroquine retinopathy at the earliest stage and should be done whenever possible.


 
  References Top

1.
Korah S, Kuriakose T. Optical Coherence tomography in a patient with chloroquine-induced maculopathy. Indian J Ophthalmol 2008;56:511-3.  Back to cited text no. 1
[PUBMED]  Medknow Journal  
2.
Shipley M, Silman A. Should patients on hydroxychloroquine have their eyes examined regularly? Br J Rheumatol 1997;36:513-5.  Back to cited text no. 2
    
3.
Silman A, Shipley M. Ophthalmological monitoring for hydroxy chloroquine toxicity: A scientific review of available data. Br J Rheumatol 1997;36:514-601.  Back to cited text no. 3
    
4.
Kellner U, Renner AB, Tillack H. Fundus autofluorescence and mfERG for early detection of retinal alterations in patients using chloroquine/hydroxychloroquine. Investig Ophthalmol Visual Sci 2006;47:3531-8.  Back to cited text no. 4
    



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1 Authors reply
Korah, S., Kuriakose, T.
Indian Journal of Ophthalmology. 2009; 57(4): 328-329
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