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Multifocal Electroretinographic Evaluation of Long-term HydroxychloroquineUsers

2004; American Medical Association; Volume: 122; Issue: 7 Linguagem: Inglês

10.1001/archopht.122.7.973

1538-3601

Raj K. Maturi,

Systemic Lupus Erythematosus Research

Objectives To observe the long-term effects of hydroxychloroquine sulfate on retinalelectrical activity by multifocal electroretinography (mfERG) and to evaluatethe regional variation of retinal dysfunction in subjects with hydroxychloroquineretinopathy. Methods Multifocal ERG with 103-hexagon stimulation was performed on 19 patients(36 eyes) treated with hydroxychloroquine for systemic lupus erythematosus,rheumatoid arthritis, or localized atypical scleroderma. Visual acuity testing,Amsler grid testing, and Ishihara color vision testing were also performed.In 2 of the patients, hydroxychloroquine was discontinued due to concernsabout toxicity. Both of these patients had additional mfERG performed afterdiscontinuation of medication. Results Twelve patients (19 eyes) had a normal response density in one or botheyes, including 6 patients (12 eyes) with a low lifetime dose (≤438 g)of hydroxychloroquine who had normal response densities in both eyes. Elevenpatients (17 eyes) had abnormal response densities in one or both eyes, and2 of these patients (4 eyes) had significant attenuation of response densitiesin almost the whole tested field; 4 patients had a normal mfERG result forone eye but had a slight decrease of response densities for the other eye.There were 4 patterns of abnormal mfERG amplitude change observed: (1) paracentralloss, (2) foveal loss, (3) peripheral loss, and (4) generalized loss. Implicittimes were abnormal for pericentral responses in 3 patients. The results ofcolor vision and Amsler grid testing were normal, except for one patient witha generalized loss pattern. In 2 subjects in whom hydroxychloroquine toxicitywas suspected, response densities improved after termination of hydroxychloroquine. Conclusions Long-term hydroxychloroquine use may be associated with mfERG abnormalities.The mfERG appears to detect retinal physiological change earlier than visualacuity testing, color vision testing, or Amsler grid testing can. The greatestvalue of the mfERG is in differentiating a retinal cause and, hence, providingimportant evidence for hydroxychloroquine toxicity, for whatever visual fieldloss is apparent on perimetry.