First Author: L.De León Monzón SPAIN
Co Author(s): N. Rodriguez Marco S. Mendez Martinez J. Obis Alfaro P. Calvo Perez
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Describes the flying saucer sign in patients with chloroquine retinopathy
Four patients with chloroquine retinopathy
Four patients with antimalarial drugs for treatment of steroid refractory systemic lupus erythematosus, two had been taking oral chloroquine at a dosage of 3 mg/kg once daily for 8 years and two had been taking oral hydroxichloroquine 200 mg once daily for 4 years. They were referred to our retina service for a screening eye examination for chloroquine toxicity. At the time of the eye examination one was asymptomatic and denied seeing deformation of straight lines on an Amsler grid test; three was symptomatic with decreased visual acuity and seeing deformation. In all cases fundoscopy showed bilateral granular hypopigmentation in an arcuate pattern around the fovea, suggestive of chloroquine toxicity. Fluorescein angiography demonstrated retinal pigment epithelium loss (RPE). Spectral domain optical coherence tomography (SD-OCT) revealed the “flying saucer” sign and, in contrast to the normal appearance of the macula, demonstrated the apparent ovoid appearance of the fovea created by preservation of the outer retinal structures in the central area surrounded by perifoveal outer retinal thinning, with posterior displacement of the inner retinal structures toward the RPE.
Our cases show the flying saucer sign through spectral domain optical coherence tomography in four patients with chloroquine retinopathy.
The patients were diagnosed as having chloroquine retinopathy, which is characterized by bilateral pigmentary macular changes, often sparing the foveal centre, and leading to a characteristic “bull’s-eye maculopathy.” The antimalarial drugs used extensively for a range of rheumatologic diseases, is associated with a low incidence of retinopathy (1–6%) when taken at recommended doses. Numerous patients take chloroquine or hidroxychloroquine for many years without problems, whereas a few develop retinal degeneration at very low cumulative doses. SD-OCT is a technique that provides a cross-sectional view of the macula in vivo. Given its increasing availability, ease of use and short acquisition time, great objectivity, and the ability to compare images from visit to visit, SD-OCT is an effective, reliable, and efficient tool to add to the protocol for chloroquine toxicity screening. In this cases the SD OCT shows a sign of macular involvement secondary to chloroquine retinopathy the ¨flying saucer sign¨