CLINICAL CHARACTERISTICS OF FOUR CASES OF PRESUMED CHLOROQUINE RETINOPATHY

Background: Chloroquine (CQ), primarily used in the management of malaria and autoimmune diseases, has long been known to cause retinal toxicity. However, modern literature with multimodal fundus imaging findings remains limited. This retrospective study explores presumed CQ retinopathy cases at a tertiary US referral center with an emphasis on multimodal fundus imaging characteristics. Methods: This was a retrospective series of cases of presumed CQ toxicity seen at the Emory Eye Center between 2015 and 2022. Results: Four men were identified with presumed CQ retinopathy, with a median age of 57 years (range 50–59 years). Chloroquine use occurred in malaria-endemic regions in each case, and the medication was self-administered in three cases. Optical coherence tomography consistently revealed outer band loss and varying degrees of foveal sparing. Fundus autofluorescence imaging demonstrated symmetric a bull's-eye pattern of autofluorescence abnormality with hyperautofluorescence along the rim of the diseased tissue. One case exhibited paravascular hyperautofluorescence in the setting of repeated intravenous CQ exposure. Conclusion: Multimodal retinal imaging revealed distinct yet diverse patterns of degeneration not readily visible on clinical examination. More generally, these findings raise public health concerns regarding self-administration of CQ in malaria-endemic regions.