Quinn Stephanie, Papastavrou Vasileios T, Warriner Clare, O'Brien Jill M, Grinton Michael E, Browning Andrew C
Visual Electrodiagnostics Service, Northern Medical Physics and Clinical Engineering, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.
Biosciences Institute, Newcastle University, Newcastle upon Tyne, UK.
Doc Ophthalmol. 2025 Oct;151(2):179-186. doi: 10.1007/s10633-025-10034-1. Epub 2025 Jun 17.
To report the early and subsequent electrophysiological findings of 2 patients following quinine overdose.
Serial assessments including: Medical history, visual acuity (VA), fundus autofluorescence, spectral-domain macular optical coherence tomography (OCT) and full-field electroretinogram (ffERG) were performed on 2 patients, between 2 and 47 days after quinine overdose.
Both patients experienced a similar clinical course. After almost total vision loss within the first 24 h, VA dramatically improved by day 3. Early OCT changes demonstrated central macula hyperautofluorescence, which coincided with a hyperreflectivity of the macular inner retina on OCT. The initial ffERG findings demonstrated changes consistent with marked inner retinal dysfunction of the cone system, affecting both the cone ON- and OFF-bipolar cell pathways. In contrast, rod bipolar cell function was unaffected in the early phase of toxicity. Between days 10 and 17, the retinal arterioles showed narrowing which coincided with attenuation of ffERG parameters of rod system inner retinal function between days 10-40.
These cases suggest the early stages of quinine toxicity affect function of the presynaptic cone bipolar cell junction. This is then followed by retinal arteriolar attenuation and the well described electronegative scotopic ffERG.
报告2例奎宁过量患者早期及后续的电生理检查结果。
对2例患者在奎宁过量后2至47天进行了一系列评估，包括：病史、视力（VA）、眼底自发荧光、光谱域黄斑光学相干断层扫描（OCT）和全视野视网膜电图（ffERG）。
2例患者临床过程相似。在最初24小时内几乎完全失明后，第3天视力显著改善。早期OCT改变显示黄斑中心高自发荧光，这与OCT上黄斑内视网膜的高反射率一致。最初的ffERG结果显示的改变与锥系统明显的内视网膜功能障碍一致，影响锥细胞ON和OFF双极细胞通路。相比之下，在中毒早期棒双极细胞功能未受影响。在第10至17天之间，视网膜小动脉变窄，这与第10至40天棒系统内视网膜功能的ffERG参数衰减一致。
这些病例表明奎宁毒性的早期阶段影响突触前锥双极细胞连接的功能。随后是视网膜小动脉变细以及众所周知的阴性暗视ffERG。
