CHLOROQUINE MACULOPATHY MASQUERADING AS CONE DYSTROPHY

Title CHLOROQUINE MACULOPATHY MASQUERADING AS CONE DYSTROPHY
Author, Co-Author Aleksandra Zlotnik, Margarita Bauman, Sherry Bass
Topic
Year
2004
Day
Program Number
Poster 97
Room
Affiliation
State University of New York, College of Optometry
Abstract BACKGROUND: Bilateral symmetric maculopaty has many etiologies among them are cone dystrophy and chloroquine maculopathy. Chloroquinolone is used in treatment and prophylaxis of malaria. The most significant complication is irreversible macular damage with visual acuity and visual field loss. Cone dystrophy, an inherited disorder, presents with bilateral maculopathy similar to chloroquine maculopathy.

CASE REPORT(S): A 47 year old African American female presented complaining of blurry vision for 1 year. Medical, ocular, family histories were negative. BCVA 20/200 OD and 20/70-OS. Pupils were PERRL with no afferent papillary defect. Slit lamp examination was unremarkable. IOPs were 20mmHg OD and 23mmHg OS. DFE revealed macular pigment mottling surrounded by areas of atrophy (Bull’s eye pattern) OD>OS. Color vision was abnormal.Visual fields demonstrated a paracentral nasal visual field defect OD and central and inferior nasal defect OS. The patient was diagnosed as an ocular hypertensive with possible cone dystrophy based on the macular appearance and color vision loss, OU and was referred for ERG testing. The ERG showed normal low photopic and scotopic amplitudes with normal latency. Based on the ERG results, additional history was elicited; which revealed that the patient was from Nigeria where she had lived for 30 years; she had had at least 3 recurrences of malaria, treated each time with chloroquine; dosage unknown; last recurrence was about 10 years ago. The ultimate diagnosis of chloroquine maculopathy was made based on the ERG testing, fundus appearance, color vision loss and patient history. The patient continues to be followed as a glaucoma suspect, but interpretation of the visual fields especially the paranasal loss OD, becomes difficult with a maculopathy such as this.

CONCLUSIONS: Chloroquine maculopathy can masquerade as cone dystrophy based clinical presentation. The ERG is especially important in making differential diagnosis because the photopic responce will be abnormal in cone dystropy,and diferential diagnosis is important for patient management.
Affiliation of Co-Authors State University of New York, College of Optometry, State University of New York, College of Optometry
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