1. GH.NADERIAN, MD

2. GH.NADERIAN MD

3. Chloroquine maculopathy
Chloroquine ( CQ)
Hydroxychloroquine (HCQ)

4. 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

5. 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

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

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

8. Duration of use >5 years
GH.NADERIAN, MD

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

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

11. Age
Age : Elderly
GH.NADERIAN, MD

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

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

14. Genetic factors ??
GH.NADERIAN, MD

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

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

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

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

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

21. Thanks for your attention