Toxicidad ocular y recuperación visual funcional en una paciente tratada con hidroxicloroquina / Ocular toxicity and functional vision recovery in a patient treated with hydroxychloroquine

Caso clínico: Presentamos un paciente de 64 años, del sexo femenino, con artritis reumatoide y síndrome de Sjögren, tratada durante 48 meses con hidroxicloroquina, a la que se le suspendió dicho tratamiento tras una revisión oftalmológica, en la que se detectó pérdida de la visión en ambos ojos asociada a defecto campimétrico paracentral, alteraciones fundoscópicas maculares pigmentarias y electrorretinograma multifocal (ERGmf) central disminuido en ambos ojos. A los 12 meses de la retirada del tratamiento, la agudeza visual y el ERGmf central habían mejorado sorprendentemente. Se trata de un caso inusual de recuperación funcional tras la retirada del tratamiento. Consideramos que el ERGmf central es una prueba más sensible que el electrorretinograma patrón en la detección de toxicidad retiniana y en la detección de mejorías visuales funcionales tras la retirada del tratamiento con hidroxicloroquina (AU)

Case report: We report the case of a 64-year-old woman with rheumatoid arthritis and Sjögren’s syndrome, treated during 48 months with hydroxychloroquine that was removed after an ophthalmological evaluation showed bilateral vision loss associated with paracentral scotoma in the visual field, fundoscopic macular pigmentary changes, and severely impaired central multifocal electrorretinogram (mfERG). Twelve months after treatment withdrawal, visual acuity and central mfERG had surprisingly improved. This is an unusual case of functional recovery after treatment withdrawal. We consider that central mfERG is a more sensitive test than pattern electrorretinogram in the detection of retinal toxicity and functional vision recovery after hydroxychloroquine treatment cessation (AU)

Ocular toxicity and functional vision recovery in a patient treated with hydroxychloroquine.

CASE REPORT: We report the case of a 64-year-old woman with rheumatoid arthritis and Sjögren's syndrome, treated during 48 months with hydroxychloroquine that was removed after an ophthalmological evaluation showed bilateral vision loss associated with paracentral scotoma in the visual field, fundoscopic macular pigmentary changes, and severely impaired central multifocal electrorretinogram (mfERG). Twelve months after treatment withdrawal, visual acuity and central mfERG had surprisingly improved. This is an unusual case of functional recovery after treatment withdrawal. We consider that central mfERG is a more sensitive test than pattern electrorretinogram in the detection of retinal toxicity and functional vision recovery after hydroxychloroquine treatment cessation.

Maculopatía en paciente con lupus eritematoso sistémico tratado con hidroxicloroquina / Maculopathy in patient with systemic lupus erythematosus treated with hydroxychloroquine

Una mujer de 50 años con lupus eritematoso sistémico, tratada 13 años con hidroxicloroquina y desde hace 5 años con nefropatía e hipertensión arterial, refirió en la revisión periódica pérdida moderada de visión en el ojo derecho. La fundoscopia mostró solo alteraciones de la pigmentación macular en el ojo derecho. El campo visual 10-2 fue normal en ambos ojos. La tomografía de coherencia óptica mostró en la mácula derecha un engrosamiento foveal hiperreflectivo, con cavidad hiporreflectiva subyacente, y fue normal en la mácula izquierda. La angiografía fluoresceínica no mostró patrón en ojo de buey, sino microaneurismas en arcadas vasculares. El electrorretinograma multifocal central estaba disminuido en el ojo derecho y el electrorretinograma patrón moderadamente disminuido en ambos ojos. En conclusión, las alteraciones del ojo derecho fueron indicativas de maculopatía isquémica, pero no de toxicidad cloroquínica (AU)

A 50-years-old woman with systemic lupus erythematosus treated for 13 years with hydroxychloroquine developed nephropathy and high blood pressure five years ago as well as moderate loss of vision in her right eye. Fundoscopy showed alterations of macular pigmentation only in the right eye. Visual fields 10-2 were normal in both eyes. Optical coherence tomography showed hyperreflective foveal thickening with a hyporreflective cavity underlying in the right macula, and was normal in left macula. Fluorescein angiography showed no bulls-eye pattern, but did show microaneurysms in vascular arcades. Multifocal central electroretinogram was diminished in right eye and the electrorretinogram pattern was diminished in both eyes. We concluded that the alterations of the right eye were suggestive of ischemic maculopathy, not hydroxychloroquine toxicity (AU)

Maculopathy in patient with systemic lupus erythematosus treated with hydroxychloroquine.

A 50-years-old woman with systemic lupus erythematosus treated for 13 years with hydroxychloroquine developed nephropathy and high blood pressure five years ago as well as moderate loss of vision in her right eye. Fundoscopy showed alterations of macular pigmentation only in the right eye. Visual fields 10-2 were normal in both eyes. Optical coherence tomography showed hyperreflective foveal thickening with a hyporreflective cavity underlying in the right macula, and was normal in left macula. Fluorescein angiography showed no bulls-eye pattern, but did show microaneurysms in vascular arcades. Multifocal central electroretinogram was diminished in right eye and the electrorretinogram pattern was diminished in both eyes. We concluded that the alterations of the right eye were suggestive of ischemic maculopathy, not hydroxychloroquine toxicity.