Asian Journal of Case Reports in Medicine and Health

Synthetic Antimalarial Maculopathy: A Case Series

Kawtar Bouirig *

Ophthalmology Department “A”, Ibn Sina University Hospital (Hôpital des Spécialités), Mohammed V University, Rabat, Morocco.

Mohamed Bentaleb

Ophthalmology Department “A”, Ibn Sina University Hospital (Hôpital des Spécialités), Mohammed V University, Rabat, Morocco.

Ibrahim Boumehdi

Ophthalmology Department “A”, Ibn Sina University Hospital (Hôpital des Spécialités), Mohammed V University, Rabat, Morocco.

Nourdine Boutimzine

Ophthalmology Department “A”, Ibn Sina University Hospital (Hôpital des Spécialités), Mohammed V University, Rabat, Morocco.

Lalla Ouafae Cherkaoui

Ophthalmology Department “A”, Ibn Sina University Hospital (Hôpital des Spécialités), Mohammed V University, Rabat, Morocco.

*Author to whom correspondence should be addressed.

---

Abstract

Synthetic antimalarials (SAM) are drugs originally used for the prevention and treatment of malaria but, because of anti-inflammatory and immuno-modulatory activities, they have been since used to treat many other pathologies. Many side effects have been attributed to them, in particular ocular toxicity represented essentially by retinopathy or chloroquine maculopathy.

This maculopathy is reversible if diagnosed at an early stage, hence the importance of early detection in patients on long-term SAM.

Our study consists of a retrospective study about fifteen patients followed for various pathologies and under long-term SAM .The study highlighted the modalities of monitoring patients, the need of the long term ophthalmological follow-up in order to detect a beginning retinal toxicity and reduce the dosage or even discontinue treatment depending on the risk-benefit ratio and possible therapeutic alternatives. An initial ophthalmologic clinical and paraclinical review must be performed before initiating treatment.

Keywords: Maculopathy, synthetic antilmalarials, monitoring, inflammatory diseases

---

---

---

References

Neubauer AS, Samari-Kermani K, Schaller U, Welge-Lübetaen U, Rudolph G, Berninger T. Detecting chloroquine retinopathy: Electro-oculogram versus colour vision. Br J Ophthalmol. 2003;87: 902-8.

JCS Yam, AKH Kwok. Ocular toxicity of hydroxychloroquine. Hong Kong Med J. 2006;12(4):294-304.

Michael F. Marmor, Ulrich Kellner, Timothy YY. Lai, FRCOphth Ronald B. Melles, William F. Mieler. Recommendations on screening for chloroquine and hydroxychloroquine retinopathy (2016 Revision). American Academy of Ophthalmology. Ophthalmology. 2016;123: 1386-1394.

Jaumouillé S, Espargillière D, Mouriaux F, Mortemousque B. Clinical evaluation of the new screening procedures for hydroxychloroquine retinopathy, according to the American Academy of Ophthalmology guidelines. Prospective study of 184 patients. J. Jfo. 2015;0:005

M. Labetoulle. Antipaludéens de synthèse: les conseils de l’American Academy of Ophthalmology. J. Fr. Ophtalmo. 2003; 26(3):319-21.

Browning DJ. Impact of the revised american academy of oph- thalmology guidelines regarding hydroxychloroquine screening on actual practice. Am J Ophthalmol. 2013; 155, 418.e1-28.e1.

Lee Y, Vinayagamoorthy N, Han K, et al. Association of polymorphisms of cytochrome P450 2D6 with blood hydroxychloroquine levels in patients with systemic lupus erythematosus. Arthritis Rheumatol 2016;68:184-90.

Melles RB, Marmor MF. The risk of toxic retinopathy in patients on long-term hydroxychloroquine therapy. JAMA Ophthalmol. 2014;132:1453–60.

Vanheesbeke A. Médicaments rétinotoxiques, rétine et épithélium pigmentaire: le point sur les APS. Bull. Soc. Belge. Ophthalmol. 2007;304:47-58.

Marmor MF, Carr RE, Easterbrook M, Farjo AA, Mieler WF. American Academy of Ophthalmology. Recommendations on screening for chloroquine and hydroxychloroquine retinopathy: a report by the American Academy of Ophthalmology. Ophthalmology. 2002;109: 1377-82.

Hart WM, JR, Burde RM, Johnston GP. Static perimetry in Chloroquine retinopathy. Perifoveal patterns of visual field depression. Arch Ophthalmol. 1984; 102:377-80.

Penrose Philip J, Tzekov Radouil T, Sutter Erich E, Arthur D. Multifocal electro-retinography evaluation for early detection of retinal dysfunction in patients taking Hydroxychloroquine. Retina. 2003;23(4): 503-12;109

So SC, Hedges TR, Schuman JS, Quireza ML. Evaluation of Hydroxychloroquine retinopathy with mf electoretinography. Ophthalmic Surg Lasers imaging. 2003; 34: 251-8.

Chen E, Brown DM, Benz MS, Fish RH, Wong TP, Kim RY, et al. Spectral domain optical coherence tomography as an effective screening test for hydroxychloroquine retinopathy (the ‘‘flying saucer’’ sign). Clin Ophthalmol. 2010; 4:1151-8.

Aduriz-Lorenzo PM, Aduriz-Llaneza P, Araiz-Iribarren J, Khamashta MA. Current opinion on hydroxychloroquine- related retinal toxicity screening: where do we stand now? Lupus. 2020;29(7):671-675.

DOI: 10.1177/0961203320919499

Epub 2020 Apr 21. PMID: 32316844.