Electrophysiological features and multimodal imaging in ritonavir-related maculopathy



The purpose of this study is to report a case of ritonavir-related retinal toxicity followed over a year. Electrophysiological features and multimodal imaging, including adaptive optics, are provided and discussed.


Electrophysiological recordings and multimodal imaging were performed and repeated over 1 year.


Fundus examination revealed crystalline maculopathy in conjunction with pigment disruption. Spectral domain optical coherence tomography displayed thinning of the macula without cysts. Autofluorescence imaging revealed a mixed pattern of complete loss of the autofluorescence in the area of retinal pigment deposit and an increased transmission of the autofluorescence in the area of retinal thinning. Fluorescein angiography ruled out parafoveal telangiectasia. Indocyanine green angiography was not contributive. Increased spacing of the macular cone mosaic, crystal deposits and pigment migrations were seen with adaptive optics. Full-field electroretinogram was slightly reduced for both eyes, especially in the light-adapted responses, and mfERG confirmed bilateral maculopathy. Functional and structural abnormalities did not change with follow-up besides constant pigmentary changes monitored with adaptive optics.


Ritonavir-related retinal toxicity is a maculopathy with peculiar features including crystalline and pigment migration associated with central or temporofoveolar thinning and inconstant macular telangiectasia. Despite drug cessation, retinal remodelling continues to progress.

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Corresponding author

Correspondence to Céline Faure.

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The authors declare that they have no conflict of interest.

Statement of human rights

All procedures performed in this study involving our human participant were in accordance with the ethical standards of the institutional and / or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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This article does not contain any studies with animals performed by any of the authors.

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Time-lapse AO movie showing the redistribution of melanosomes inside melanin-loaded cells (MP4 931 kb). The migration of th melanin pigments suggest a continuous process of remodelling of the scar tissue

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Faure, C., Paques, M. & Audo, I. Electrophysiological features and multimodal imaging in ritonavir-related maculopathy. Doc Ophthalmol 135, 241–248 (2017). https://doi.org/10.1007/s10633-017-9612-z

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  • Ritonavir maculopathy
  • Crystalline maculopathy
  • Toxic maculopathy
  • Phospholipidosis