Clinical Characteristics of Four Cases of Presumed Chloroquine Retinopathy

Chloroquine (CQ), primarily used in the management of malaria and autoimmune diseases, has long been known to cause retinal toxicity. However, modern literature with multimodal fundus imaging findings remains limited. This retrospective study explores presumed CQ retinopathy cases at a tertiary United States referral center with an emphasis on multimodal fundus imaging characteristics. Retrospective series of cases of presumed CQ toxicity seen at the Emory Eye Center between 2015-2022. Four males were identified with presumed CQ retinopathy, with median age of 57 years (range 50-59 years). CQ use occurred in malaria-endemic regions in each case, and the medication was self-administered in three cases. Optical coherence tomography consistently revealed outer band loss and varying degrees of foveal sparing. Fundus autofluorescence imaging demonstrated symmetric bull’s eye pattern of AF abnormality with hyperautofluorescence along the rim of diseased tissue. One case exhibited para-vascular hyperautofluorescence in the setting of repeated intravenous CQ exposure. Multimodal retinal imaging revealed distinct yet diverse patterns of degeneration not readily visible on clinical examination. More generally, these findings raise public health concerns regarding self-administration of CQ in malaria-endemic regions.