Based on experience and analysis of a few articles, devoted to this topic, the authors diagnose and describe the clinical case of the rare symptoms' group, associated with taking of hydroxychloroquine by the patient with sarcoidosis and diabetes type 1. The diagnostics of this lesion is difficult problem in the regular ophthalmologic practice, because of the uncommon disease, the lack of information and continuity between specialists, especially rheumatologists and pulmonologists. The recommendations of American Academy of Ophthalmology for effective screening of patients undergoing hydroxychloroquine therapy are given in this report.

Full Text



  1. Goodman L.S., Gilman A. The Pharmacological Basis of Therapeutics. New York: Macmillan, 1975. P. 1049-64.
  2. The History of Malaria, an Ancient Disease. Atlanta, GA: Centers for Disease Control and Prevention.
  3. Kalia S., Dutz J.P. New concepts in antimalarial use and mode of action in dermatology // Dermatologic Therapy. 2007. Vol. 20 (4). P. 160-174.
  4. Cambiaggi A. Unusual ocular lesions in a case of systemic lupus erythematosus. AMA // Arch. Ophthalmol. 1957. Vol. 57. P. 451-3.
  5. Shearer R.V., Dubois E.L. Ocular changes induced by long term hydroxychloroquine (Plaquenil) therapy //Am. J. Ophthalmol. 1967. Vol. 64. P. 245-252.
  6. McChesney E.W. Animal toxicity and pharmacokinetics of hydroxychloroquine sulfate // Am. J. Med. 1983. Vol. 75. P. 11-18.
  7. Инструкция по применению к препарату ГХ a21ba25ba94ba23b.
  8. Easterbrook M. The ocular safety of hydroxychloroquine // Semin. Arthritis & Rheumatism. 1993. Vol. 23 (2 Suppl 1). P. 62-67.
  9. Shroyer N.F., Lewis R.A., Lupski J.R. Analysis of the ABCR(ABCA4) gene in 4aminoquinoline retinopathy //Am. J. Opthalmol.2001. Vol. 131. P. 761-6.
  10. Yam J.C., Kwok A.K. Ocular toxicity of hydroxychloroquine // Hong Kong Med. J. 2006. Vol. 12 (4). P. 294304.
  11. Bernstein H.N. Chloroquine ocular toxicity // Surv. Ophthalmol. 1967. Vol. 12. P. 415-47.
  12. Jones S.K. Ocular toxicity and hydroxychloroquine: guidelines for screening // Br. J. Dermatology. 1999. Vol. 140. P. 37.
  13. Tehrani R., Ostrowski R.A., Hariman R., Jay W.M. Ocular toxicity of hydroxychloroquine // Semin. Ophthalmology. 2008. Vol. 23 (3). P. 201-209.
  14. Клиническая офтальмология. Систематизированный подход. Дж. Кански. 2009. 944 с.
  15. GonzalezNoriega A., Grubb J.H., Talkad V., Sly W.S. Chloroquine inhibits lysosomal enzyme pinocytosis and enhances lysosomal enzyme secretion by impairing receptor recycling // J. Cell Biol. 1980. Vol. 85. P. 839-852.
  16. Levy G.D., Munz S.J., Paschal J. et al. Incidence of hydroxychloroquine retinopathy in 1,207 patients in a large multicenter outpatient practice // Arthritis Rheum. 1997. Vol. 40. P. 1482-86.
  17. Weisinger H.S., Pesudovs K., Collin H.B. Management of patients undergoing hydroxychloro quine (Plaquenil) therapy // Clin. Exp. Optom. 2000. Vol. 83. P. 32-36.
  18. Rosenthal A.R., Kolb H., Bergsma D. et al. Chloroquine retinopathy in the rhesus monkey // Invest. Ophthalmol. Vis. Sci. 1978. Vol. 17. P. 1158-75.
  19. Marmor M.F., Carr R.E., Easterbrook M. et al. Recommendations on screening for chloroquine and hydroxychloroquine retinopathy: a report by the American Academy of Ophthalmology // Ophthalmology. 2002. Vol. 109 (7). P. 1377-82.
  20. RodriguezPadilla J.A., Hedges T.R., 3rd, Monson B. et al. Highspeed ultrahighresolution optical coherence tomography findings in hydroxychloroquineretinopathy //Arch. Ophthalmol. 2007. Vol. 125 (6). P. 775-80.
  21. Hodgkinson B.J., Kolb H. A preliminary study of the effect of chloroquine on the rat retina // Arch. Ophthalmol. 1970. Vol. 84. P. 509-15.
  22. Tzekov R. Ocular toxicity due to chloroquine and hydroxychloroquine: electrophysiological and visual function correlates // Doc. Ophthalmol. 2005. Vol. 110 (1). P. 111-120.
  23. Rynes R.I. Antimalarial drugs / Textbook of Rheumatology. In: Kelley WN, Harris ED, Ruddy S, Sledge CB eds. Textbook of Rheumatology, Philadelphia: W.B. Saunders Co., 1997. P.747-58.
  24. Ivanina T.A., Zueva M.V., Lebedeva M.N. et al. Ultrastructural alterations in rat and cat retina and pigment epithelium induced by chloroquine // Graefes Arch. Clin. Exp. Ophthalmol. 1983. Vol. 220 (1). P. 32-38.
  25. Kuhn H., Keller P., Kov
  26. Leblanc B., Jezequel S., Davies T. et al. Binding of drugs to eye melanin is not predictive of ocular toxicity // Regul. Toxicol. Pharmacol. 1998. Vol. 28. P. 124-32.
  27. Duncker G., Bredehorn T. Chloroquineinduced lipidosis in the rat retina: functional and morphological changes after withdrawal of the drug. // Graefes Arch. Clin. Exp. Ophthalmol. 1996. Vol. 234. P. 378-81.
  28. Duncker G., Schmiederer M., Bredehorn T. Chloroquineinduced lipidosis in the rat retina: a functional and morphological study // Ophthalmologica. 1995. Vol. 209. P. 79-83.
  29. Gregory M.H., Rutty D.A., Wood R.D. Differences in the retinotoxic action of chloroquine and phenothiazine derivatives // J. Pathol. 1970. Vol. 102. P. 139-50.
  30. Tanenbaum L., Tuffanelli D.L. Antimalarial agents. Chloroquine, hydroxychloroquine, and quinacrine // Arch. Dermatol. 1980. Vol. 116. P. 587-591.
  31. Wada A., Sakurai S., Kobayashi H. et al. Suppression by phospholipase A2 inhibitors of secretion of catecholamines from isolated adrenal medullary cells by suppression of cellular calcium uptake // Biochem. Pharmacol. 1983. Vol. 32. P. 1175-78.
  32. Yanoff M., Tsou K.C. A tetrazolium study of the whole eye: effect of chloroquine in the incubation medium // Am. J. Ophthalmol. 1965. Vol. 59. P. 808-810.
  33. Almony A., Garg S., Peters R.K. et al. Threshold amsler grid as a screening tool for asymptomatic patients on hydroxychloroquine therapy // Br. J. Ophthalmol. 2005. Vol. 89 (5). P. 569-574.
  34. Razeghinejad M.R., Torkaman F., Amini H. Blueyellow perimetry can be an early detector of hydroxychloroquine and chloroquine retinopathy // Med. Hypotheses. 2005. Vol. 65 (3). P. 629-630.
  35. Vu B.L., Easterbrook M., Hovis J.K. Detection of color vision defects in chloroquine retinopathy // Ophthalmology. 1999. Vol. 106. P. 1799-1803.
  36. Moschos M.N., Moschos M.M., Apostolopoulos M. et al. Assessing hydroxychloroquine toxicity by the multifocal ERG // Doc. Ophthalmol. 2004. Vol. 108. P. 47-53.
  37. Nylander U. Ocular damage in chloroquine therapy // Acta Ophthalmol (Copenh). 1967. Suppl 92. P. 171.
  38. Tzekov R.T., Serrato A., Marmor M.F. ERG findings in patients using hydroxychloroquine // Doc. Ophthalmol. 2004. Vol. 108. P. 87-97.
  39. Royal College of Ophthalmologists. Chloroquine, Hydroxychloroquine and the Eye. London: RCO, 1993.
  40. Easterbrook M. Is corneal deposition of antimalarial any indication of retinal toxicity? // Can. J. Ophthalmol. 1990. Vol. 25. P. 249-251.



Abstract - 247

PDF (Russian) - 246


Article Metrics

Metrics Loading ...


Copyright (c) 2011 Kazaryan A.A., Ponomareva E.N.

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies