Here we report two cases of macular edema patients associated with hydroxychloroquine (HCQ) maculopathy.
Methods
Observational case reports
Results
First case is a 47-year-old woman having blurry vision and micropsia in the right eye. She has history of Hashimoto thyroiditis and has HCQ for 13 years, with cumulative HCQ dose of 1848 g. Fundus autofluorescence showed mild hypopigmentation and hyperpigmentation surrounding the fovea. Macular OCT revealed parafoveal and peripheral IS/OS disruption with cystoid macular change in both eyes. After cessation of HCQ and addition of topical carbonic anhydrase inhibitor, her macular edema improved. Best corrected visual acuity (BCVA) returned to 20/20.
Second case is a 51-year-old woman with blurred vision of both eyes. She has recurrent CME of idiopathic condition and had received intravitreal triamcinolone (TA) injections for both eyes. She has rheumatoid arthritis and was under HCQ for more than 10 years. FAF showed the typical bull’s eye pattern of HCQ maculopathy. OCT revealed cystoid edema with flying saucer appearance. After cessation of HCQ and intravitreal injection of TA, macular edema improved and BCVA returned to 20/25.
Conclusion
HCQ retinopathy with macular edema is rare. Thus far only 10-20 cases had been reported to date in literature. It is present with advanced retinopathy with RPE involvement, and its mechanism is unknown. For these patients, it is important to inquire the appropriate medical history to arrive at the correct diagnosis. Most importantly, to stop HCQ treatment right away, as macular edema may spontaneously resolve after drug cessation. Carbonic anhydrase inhibitors or intravitreal triamcinolone may be effective if edema does not spontaneously resolve.
Conflict of interest
No
Details of conflicting interests
Nil
1
Last name
HUANG
Initials of first name(s)
JCC
Department
Department of Ophthalmology
City
Keelung City
Country
Taiwan
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