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Journal de Pharmacie Clinique

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Synthetic antimalarials maculopathy: a case report Volume 30, issue 1, Mars 2011

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Service d’ophtalmologie, CHU Habib Bourguiba, Sfax, Tunisie

<p>We discuss, through the case of maculopathy with antimalarials (AM) revealed by progressive bilateral decrease in vision in a patient with lupus, the modalities of monitoring patients treated with AM and the management of a potential intoxication.</p><p>48 year-old patient, with a history of systemic erythematous lupus (SEL) since 1987, treated by Nivaquine (AM) addressed to a bilateral gradual decline of vision. The ophthalmological assessment found a corrected vision of 2/10 right and 1.5/10 left. The fundus examination showed a rosette appearance maculopathy in both eyes. The fluorescein angiography showed a picture bull's-eye bilaterally. The electroretinogram showed signs of retinopathy in accordance with bilateral maculopathy with AM. In consultation with internists, it was decided to stop Nivaquine. The outcome was favorable with improvement in vision.</p><p>all authors stress the need for clinical and paraclinical ophthalmological monitoring regularly to detect early signs of impaired retinal function at a reversible stage. Indeed, at a more severe retinal intoxication, impaired visual function remains irreversible and can lead to blindness. A full ophthalmologic assessment is necessary before starting long course treatment with AM, possibly coupled with additional tests (central visual field, color vision and / or electrophysiological examinations). Regular monitoring is then indicated. When a beginning retinal toxicity is diagnosed, it should be discussed with the treating physician, depending on the risk-benefit ratio and possible therapeutic alternatives, discontinuation or adjustment of treatment. In cases of poisoning with proven impact on vision and significant alteration of the visual field, stopping AM becomes indisputable as it may lead to an irreversible blindness.</p><p>AM treatments still require careful attention to avoid iatrogenic irreversible retinal blinding intoxication. An initial ophthalmologic clinical and paraclinical review must be performed before initiating treatment. Regular monitoring allows the diagnosis of incipient intoxication at a “preclinical” stage.</p>