Abstract

Chloroquine and hydroxychloroquine have been used over the years for the treatment of malaria and rheumatic diseases. It was also proposed for the treatment of COVID-19 in the solidarity and recovery clinical trials that have been suspended by the World Health Organisation (WHO). Malaria remains a leading cause of morbidity and mortality in endemic regions of West Africa. The desire to stay malaria-free can make some people indulge in chemoprophylaxis, using readily available over the counter medications such as chloroquine and hydroxychloroquine. The mechanism of retinal toxicity from these agents is thought to be due to their high affinity for melanin in the retinal pigment epithelium through the activity of OATP1A2, a polypeptide involved in the recycling of all trans-retinol. With the advent COVID-19, the use of hydroxychloquine may increase, predisposing more people to the harmful effects of these drugs. There is need to establish a baseline macular function before treatment with hydroxychloroquine, in line with the recommendations of the American Academy of Ophthalmology. This article reports the case of hydroxylchloroquine maculopathy after twenty years of chemoprophylaxis for malaria.

Keywords: Hydroxychloroquine; Malaria; Toxic maculopathy; Irreversible blindness; COVID-19; Bull’s eye maculopathy

Abbreviations: HCQ: Hydroxychloroquine; SLE: Systemic Lupus Erythematosus; RPE: Retinal Pigment Epithelium; MFERG: Multifocal Electroretinogram; AAO: American Academy of Ophthalmology