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Case Series
Non-leaking cystoid macular edema and bull’s eye maculopathy caused by hydroxychloroquine toxicity in Asian patients
1 Department of Ophthalmology, Hospital Kuala Lumpur, 50586 Kuala Lumpur, Malaysia
2 Department of Ophthalmology, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, 56000 Cheras, Kuala Lumpur, Malaysia
Address correspondence to:
Low Kah Ling
Department of Ophthalmology, Hospital Kuala Lumpur, 50586 Kuala Lumpur,
Malaysia
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Article ID: 100032Z17LL2022
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Ling LK, Tarmidzi NAA, Ishak H, Rahmat J, Hamzah JC. Non-leaking cystoid macular edema and bull’s eye maculopathy caused by hydroxychloroquine toxicity in Asian patients. J Case Rep Images Opthalmol 2022;5(2):16–20.ABSTRACT
Introduction: Hydroxychloroquine (HCQ) is used for treating systemic lupus erythematosus (SLE). It can cause irreversible toxic retinopathy, we discuss the outcome of HCQ retinopathy and emphasize the distinct toxicity pattern in Asian patients.
Case Series: We report a retrospective case series of two systemic lupus erythematosus (SLE) patients who presented with HCQ toxicity. Both Asian SLE patients were treated with HCQ over five years with cumulative dose of >1000 g. Both had characteristic findings on spectral domain optical coherence tomography (SD-OCT) and fundus autofluorescence (FAF). First patient had non-leaking cystoid macula edema (CME) associated with HCQ retinopathy and second patient had bull’s eye maculopathy (BEM). They exhibited different outcome after drug cessation. There was no disease progression in former whereas latter lost her central vision over two years.
Conclusion: Non-leaking CME is rare and can be a sequence of HCQ retinopathy. Bull’s eye maculopathy is another manifestation of severe HCQ toxicity. Toxic damage to retina is irreversible, and may progress even after the drug is stopped, so is crucial to discontinue once toxicity is detected. Patients on HCQ warrant annual screening with multimodal imaging. There are racial differences in HCQ toxicity, hence distinct screening tests should be performed in Asian population.
Keywords: Cystoid macula edema, Hydroxychloroquine, Maculopathy
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Acknowledgments
The authors would like to acknowledge the Department of Ophthalmology of Hospital Kuala Lumpur for their contributions to the realization of this manuscript.
Author ContributionsLow Kah Ling - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Drafting the article, Final approval of the version to be published
Nor Azita Ahmad Tarmidzi - Substantial contributions to conception and design, Revising it critically for important intellectual content, Final approval of the version to be published
Hamisah Ishak - Substantial contributions to conception and design, Revising it critically for important intellectual content, Final approval of the version to be published
Guaranter of SubmissionThe corresponding author is the guarantor of submission.
Source of SupportNone
Consent StatementWritten informed consent was obtained from the patient for publication of this article.
Data AvailabilityAll relevant data are within the paper and its Supporting Information files.
Conflict of InterestAuthors declare no conflict of interest.
Copyright© 2022 Low Kah Ling et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.
