Background: Chloroquine keratopathy is known as a disease with epithelial deposits in the cornea. The appearance of corneal changes does not seem to be related to dose and duration of treatment. Chloroquine accumulates in lysosomes. The purpose of this study was to investigate microscopic changes of corneal morphology in patients treated with chloroquine in vivo.
Patients and methods: Using the confocal slit scanning microscope, we examined 16 patients during chloroquine treatment and 4 patients after treatment. The patients' age was between 33 and 75 years. They were treated with chloroquine over a minimum period of 2 months up to a maximum period of 10 years.
Results: In 12 of 20 patients, corneal changes were visible. An atypical inverse reflectivity of basal cells in comparison to healthy volunteers was found. There were also deposits in the wing cell layer. We saw a higher density in the anterior stroma before the appearance of epithelial opacities, as well as in cases of keratopathy on slit-lamp examination and also after the cessation of chloroquine treatment. In one patient with long-term therapy, there were atypically shaped and branched nerves in the anterior stroma.
Conclusions: Using confocal microscopy, it was in some cases possible to detect changes in the corneal morphology before these changes could be detected by slit-lamp examination. As a result of this study we found that chloroquine keratopathy is not limited to the epithelium but can affect the anterior stroma and possibly neural structures.