GH.NADERIAN, MD

GH.NADERIAN MD

Chloroquine maculopathy Chloroquine ( CQ) Hydroxychloroquine (HCQ)

The first reports concerned long term use of CQ for malaria and later reports showed retinopathy after treatment of anti- inflammatory disease GH.NADERIAN, MD

The mechanism of CQ and HCQ toxicity is not well understood Acute effects on the metabolism of retinal cells Bind to melanin in the RPE

The clinical picture of CQ and HCQ toxicity is characterized classically by bilateral bulls eye GH.NADERIAN, MD

Factors increasing the risk of CQ and HCQ retinopathy: GH.NADERIAN, MD

Duration of use >5 years GH.NADERIAN, MD

Cumulative dose HCQ > 1000 gr (total) CQ > 460 gr (total) GH.NADERIAN, MD

Daily dose HCQ > 400 mg / day CQ > 250 mg / day GH.NADERIAN, MD

Age Age : Elderly GH.NADERIAN, MD

Systemic disease : kidney or liver dysfunction GH.NADERIAN, MD

Ocular disease : retinal disease or maculopaty GH.NADERIAN, MD

Genetic factors ?? GH.NADERIAN, MD

American Academy Of Ophthalmology (feb 2011) Recommendations on screening for CQ and HCQ retinopathy GH.NADERIAN, MD

Time line Base line examination within first year of use Annual screening after 5 years of use GH.NADERIAN, MD

Recommended screenig procedures Ocular examination Automated visual field GH.NADERIAN, MD

In addition , if available , perform one or more of the following objective tests SD - OCT mf ERG FAF (fundus auto fluroscence)

Not recommended for screening Fundus photography Time –domain OCT FA Amsler grid Color testing EOG

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