The ERG Contribution in Early Diagnosis of Chloroquine and Hydroxychloroquine Maculopathy

Authors: M. Karkanová ;  V. Matušková ;  E. Vlková ;  H. Došková ;  R. Uhmannová
Authors‘ workplace: Oční klinika LF MU a FN Brno, přednostka prof. MUDr. E. Vlková, CSc.
Published in: Čes. a slov. Oftal., 66, 2010, No. 2, p. 62-66


Derivates of chloroquine (Plaquenil, Delagil), used for long-term treatment of rheumatic diseases, may cause clinically proven irreversible maculopathy, which may progress even after the discontinuation of their application.

The optimal early diagnosis of ocular toxicity of chloroquine or hydroxychloroquine drug remains controversial up to now. The aim of this review paper was to evaluate how appropriate is the indication of the electroretinographic (ERG) examination due to the early diagnosis of cumulative drug-related maculopathy.

Photopic, pattern, and multifocal ERG (Retiscan, according to the ISCEV methodology) were examined in 10 patients (20 eyes) treated by means of antimalarics, 9 due to the rheumatoid arthritis (RA) and 1 due to the systemic lupus erythremathodes (SLE). The average age of the patients was 60 ± 15 years, the treatment period was 10 ± 11 years; the median of the treatment period was 5 years. The control group consisted of 12 healthy, age matched patients (20 eyes) without any obvious ocular pathology.

In all of them, the complete ophthalmologic examination was performed: the best corrected visual acuity (BCVA) for far using the Snellen charts, intraocular pressure (IOP) measured by means of the non contact tonometer NIDEK NT-2000, the Amsler grid test, examination of the anterior segment and the posterior segment with the slit lamp. The entry criteria in both groups were BCVA 5/7,5 (0.67) and better, the IOP in the normal range, negative Amsler grid test, anterior segment without significant decrease of the transparency, and physiological posterior segment or with subtle granular pigment dysgrupancies in the macula only. The significant difference between the group treated with chloroquine or hydrochloroquine and the control group at the 1 % level of significance was found in following parameters: in the photopic ERG the value of the b wave latency [ms], in pattern ERG, the values of the waves N35 - P50 [μV] and P50 – N95 [μV] amplitudes, and at the 5 % level of significance in photopic ERG, the wave a amplitude value [μV] and in multifocal ERG, the value of the P1 [ms] a N1 [ms] parts latency in the pericentral ring. It follows from the results, that the ERG examination is suitable for the early diagnosis drug cumulative maculopathy caused by chloroquine derivates. Optimal is the individual comparison of the ERG values of the patient before and in certain time intervals after the beginning of the chloroquine derivates treatment.

Key words:
ERG, antimalarics, drug cumulative maculopathy


1. Araiza-Casilas, R., Cárdenas, F., Morales, Y.: Factors associated with chloroguine-induced retinopathy in rheumatic diseases. Lupus. 2004, 13, s. 119–124

2. Bui Quoc, E., Ingster-Moati, I., Rigolet, MH.: Ophthalmologic prevention of chloroguine and hydroxychloroguine induced retinopathy. Annales de Dermatologie et de Venerologie. 2005, 132, 4, s. 329–337

3. Cambiaggi, A.: Unusual ocular lesions in case of systemic lupus erythematodes. AMA Arch. Ophthalmol. 1957, 57, s. 451–453

4. Easterbrook, M., Bernstein, H.: Ophthalmological monitoring of patients taking antimalarials: preferred practice pattern. The Journal of Rheumatology. 1997, 24, 7, s. 1390–1392

5. Easterbrook, M.: An ophthalmological view on the efficacy and safety of chloroguine versus hydroxychloroquine. J. Rheumatol. 1999, 26, s. 1866–1868

6. Fardet, L., Revuz, J.: Synthetic antimalarials. Annales de Dermatologie et de Venereologie. 2005, 132, 8–9, s. 665–674

7. Grierson, DJ.: Hydroxychloroguine and visual screening in a rheumatology outpatient clinic. Annals of Rheumatic Diseases. 1997, 56, 3, s. 188–191

8. Hobbs, HE., Sorsby, A., Freedman, A.: Retinopathy following chloroguine therapy. Lancet. 1959, 2, s. 478

9. Ingster-Moati, I., Bui Quoc, E., Crochet, M.: Severe chloroquine and hydroxychloroquine induced retinopathy. Journal Francais d Opthalmologie. 2006, 29, 6, s. 642–650

10. Ingster-Moati, I., Crochet, M., Albuisson, E.: Electroretinogram b wave varies with the posology of the antimalarial treatment. Journal Francais d Opthalmologie. 2004, 27, 12, s. 1007–1012

11. Karkanová, M., Polanská, V., Vícha, I. et al.: Přínos ERG při screeningu chlorochinové a hydroxychlorochinové makulopatie, 55, In: Sborník abstrakt XV. výročního sjezdu České oftalmologické společnosti s mezinárodní účastí v Brně. Ed. Nucleus HK, 2007, s. 187, ISBN 978-80-87086-01-08.

12. Lai, T.Y., Ngai, J.W., Chan, W.M.: Visual field and multifocal electroretinography and their correlations in patients on hydroxychloroguine therapy. 2006, 112, 3, s. 177–187

13. Maturi, R.K., Yu, M., Weleber, R.G.: Multifocal electroretinographic evaluation of long-term hydroxychloroguine users. Archives of Ophthalmology. 2004, 122, 7, s. 973–981

14. Mavrikakis, I. et al.: The incidence of irreversible retinal toxicity in patients treated with hydroxychloroguine: a reappraisal. Ophthalmology. 2003, 110, 7, s. 1321–1326

15. Neubauer, AS., Stiefelmeyer, S., Berninger, T.: The multifocal pattern electroretinogram in chloroguine retinopathy. Ophthalmic Research. 2004, 36, 2, s. 106–113

16. Rigaudiere, F., Ingster-Moati, I., Hache, J.C.: Up-dated ophthalmological screening and follow-up management for long-term antimalarial treatment. Source Journal Francais d Ophthalmologie. 2004, 27, 2, s. 191–199

17. Scherbel, A.L., Mackenzie, A.H., Nousek, J.E.: Ocular lesions in rheumatoid arthritis and related disorders with particular reference to retinopathy. The New England Journal of Medicine. 1965, 12, 8, s. 360–366

18. Svěrák, J., Erbenová, Z., Peregrin, J.: ERG and EOG potentials after 6 years rescoring treatment. Sborník vědeckých prací Lékařské fakulty UK v Hradci Králové. 1971, 14, 2, s. 209–213

19. Svěrák, J., Peregrin, J., Salavec, M.: Electrophysiological methods of examination during prolonged administration of synthetic antimalarial drugs. Sborník vědeckých prací Lékařské fakulty UK v Hradci Králové. 1976, 19, 3–4, s. 427–434

20. Svěrák, J., Salavec, M., Peregrin, J.: Vliv antimalarik na činnost sítnice. Čs. Oftal. 1965, 21, 5, s. 370–378

21. Tokumaru, G.K.: New considerations in monitoring for hydroxychloroguine retinopathy. Clinical Eye and Vision Care. 1996, 8, s. 99–104

22. Tzekov, R.: Ocular toxicity due to chloroquine and hydroxychloroquine: electrophysiological and visual function correlates. Documenta Ophthalmologica. 2005, 110, s. 111–120

23. Wei, L.C., Chen, S.N., Ho, C.L.: Progression of hydroxychloroguine retinopathy after discontinuation of therapy. Chang Gung Medical Journal. 2001, 24, 5, s. 329–334

Forgotten password

Don‘t have an account?  Create new account

Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.


Don‘t have an account?  Create new account