Dapsone Maculopathy

After the injection of about 10 gm of dapsone, a 38-year-old male showed a whitish-yellow patch in the macular region of both eyes, with decreased visual acuity of the counting finger in the right and 0.04 in the left eye. Two weeks after the start of systemic steroid therapy the patch disappeared, and on follow-up at 11 months, visual acuity was 0.02 in the right and 0.08 in the left eye, with macular degeneration and foveal nonperfusion. This retinal damage seems to be ischemic in origin and to be caused by a combination of acute severe peripheral hypoxemia and the vascular obstructive effect of red cell fragmentation resulting from massive hemolysis.