Ocular toxicity of chloroquine among Thai patients

Abstract

The present study confirms the finding reported by Mackenzie (Am J Med 1983; 75 (Suppl 1A): 40-45) that retinopathy is not related to the duration of treatment and cumulative dose of chloroquine. Based on our finding that retinopathy can be detected as early as 9 months after starting chloroquine therapy, we recommend routine ophthalmic examination before treatment and every 6 months thereafter.

Prevalence and risk factors for chloroquine maculopathy and role of plasma chloroquine and desethylchloroquine concentrations in predicting chloroquine maculopathy

“…15 The prevalence of CM from international studies varied from 0.001 to 40%, [16][17][18] while studies in Thailand reported a prevalence of 2.4-31.4%. 11,14,[19][20][21][22] The differences in CM prevalence might be due to the variation of methods used for diagnosis, which varied from only dilated ocular examination, 20 Humphrey Visual Field (HVF) 10-2 red 11 or white target, 21 to a combination of ocular examination and automated visual field. 14,19,20 Currently, AAO has revised the recommendations on screening for AM retinopathy and suggested that the diagnosis of CM should be based on a combination of dilated ocular examination to detect associated retinal disorders, and HVF 10-2 white protocol (HVF10-2w).…”

Case report: Retinopathy after malaria prophylaxis with chloroquine.

“…Despite the fact that CR has already been extensively described in the literature, the dosing regimen and the total dose of chloroquine associated with the risk of retinopathy are still controversial. 7,8 Chloroquine retinopathy was initially described in patients receiving an overdose of this drug. 3,9,10 Further cases of maculopathy were reported in subjects who used chloroquine prophylaxis at 100 mg daily for Ͼ 10 years, with cumulative doses ranging 300-1,300 g. [11][12][13][14] It has been suggested that a cumulative dose of Ͼ 700 g might be toxic, corresponding to a prophylaxis of 100 mg per day for 20 years.…”

Toxicidade ocular causada pela cloroquina: relato de caso

“…A retinopatia pela cloroquina é irreversível e freqüentemente progressiva, estando relacionada com a dosagem cumulativa e à duração do tratamento (1,(4)(5)(6)(7) . Há relatos de detecção precoce e tardia variando de 9 meses após início do tratamento a 7 anos depois de cessado o mesmo (8)(9) . Num estudo com pacientes usuários de cloroquina sem alterações no exame de fundo de olho, a sensibilidade ao contraste esteve dentro dos valores normais; porém a extensão das perdas na discriminação de cores foi positivamente correlacionada com a dose acumulada (10) .…”

“…A ceratopatia pode ser encontrada depois de 3 dias do início da terapia, sendo reversível com a descontinuidade da droga (8) . Não há prejuízo da acuidade visual e nenhuma diferença foi observada entre sexo, idade, duração do tratamento e dose acumulada (5,8,11) .…”

“…Não há prejuízo da acuidade visual e nenhuma diferença foi observada entre sexo, idade, duração do tratamento e dose acumulada (5,8,11) . A dose diária da droga parece determinar o desenvolvimento da doença ocular, não devendo ultrapassar 4 mg/kg/dia.…”