Bergholz Richard, Rossel Mirjam, Schroeter Jan, Dutescu Ralf M, Salchow Daniel J
Department of Ophthalmology, Charité - Universitätsmedizin Berlin, Germany.
University Tissue Bank, Institute of Transfusion Medicine, Charité - Universitätsmedizin Berlin, Germany.
Retin Cases Brief Rep. 2018;12(2):81-86. doi: 10.1097/ICB.0000000000000454.
BACKGROUND/PURPOSE: Toxic maculopathy is a rare but severe complication of chloroquine intake. Although the phenotype of established maculopathy was analyzed in detail, few data exist on the ophthalmologic findings in the early stage.
The authors present 4 female patients with unequivocal signs of chloroquine maculopathy (bilateral [peri-]central scotoma in the visual fields, structural alterations of the macula in the optical coherence tomography) but normal or atypical findings as to fundus autofluorescence imaging.
In all patients, optical coherence tomography showed perifoveal thinning and subtle alterations of the outer retinal layers. In one patient, the latter was limited to the pericentral region, whereas it showed a more diffuse distribution in two other patients. One patient showed a combination of pericentral and diffuse damage. Multifocal electroretinography was recorded in three patients and revealed the typical (peri-)central amplitude reductions.
A normal fundus autofluorescence does not rule out toxic maculopathy. Optical coherence tomography and multifocal electroretinography seem to be more sensitive in the early stage of the disease. In case of typical complaints and visual fields, the optical coherence tomography has to be evaluated for subtle alterations of the outer retina. Their presence justifies the cessation of the drug. Multifocal electroretinography may be of special value in these problematic cases.
背景/目的：中毒性黄斑病变是氯喹摄入罕见但严重的并发症。尽管已对确诊黄斑病变的表型进行了详细分析，但关于早期眼科检查结果的数据较少。
作者报告了4例明确有氯喹黄斑病变体征的女性患者（视野双侧[周边]中心暗点，光学相干断层扫描显示黄斑结构改变），但眼底自发荧光成像结果正常或不典型。
所有患者的光学相干断层扫描均显示黄斑中心凹周围变薄及视网膜外层细微改变。1例患者中，后者局限于中心周围区域，而在另外2例患者中显示出更广泛的分布。1例患者表现为中心周围和弥漫性损伤的组合。3例患者进行了多焦视网膜电图检查，结果显示典型的（周边）中心振幅降低。
正常的眼底自发荧光不能排除中毒性黄斑病变。光学相干断层扫描和多焦视网膜电图在疾病早期似乎更敏感。出现典型症状和视野改变时，必须评估光学相干断层扫描以发现视网膜外层的细微改变。这些改变的存在说明应停用该药物。在这些疑难病例中，多焦视网膜电图可能具有特殊价值。
