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DOI: 10.1055/a-1098-8542
Keeping an Eye on Hydroxychloroquine Retinopathy
Die Hydroxychloroquin-Retinopathie im Auge behaltenBackground
Hydroxychloroquine (HCQ) is an immunomodulatory agent, initially used to treat malaria, but nowadays mainly used for treating rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE). Despite its generally safe profile, there is a risk of retinal toxicity directly related to dose and duration of treatment. The incidence of HCQ-induced macular toxicity has been estimated to be under 1% up to 5 years, under 2% up to 10 years, and reaches almost 20% after 20 years of use [1]. A safe dose of HCQ is either a daily dose ≤ 5 mg/kg real body weight (RBW) [1] or a total dose < 1000 g. Due to the risk of developing an irreversible macular toxicity, regular examination by ophthalmologists is needed. We present two exemplary cases of HCQ retinal toxicity referred to our unit, demonstrating either a successful early detection at an asymptomatic stage or a late detection of a severely symptomatic patient. Investigations included full ophthalmic examination, 10 – 2 visual fields (10 – 2 VF), fundus autofluorescence (FAF), macular spectral domain optical coherence tomography (SD-OCT), and multifocal electroretinogram (mf-ERG). We also describe the screening guidelines followed in our institution.
Publication History
Received: 25 September 2019
Accepted: 30 December 2019
Article published online:
04 March 2020
Georg Thieme Verlag KG
Stuttgart · New York
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References
- 1 Melles RB, Marmor MF. The risk of toxic retinopathy in patients on long-term hydroxychloroquine therapy. JAMA Ophthalmol 2014; 132: 1453-1460 doi:10.1001/jamaophthalmol.2014.3459
- 2 Marmor MF, Kellner U, Lai TYY. et al. American Academy of Ophthalmology Statement: Recommendations on Screening for Chloroquine and Hydroxychloroquine Retinopathy (2016 Revision). Ophthalmology 2016; 123: 1386-1394 doi:10.1016/j.ophtha.2016.01.058
- 3 Yusuf IH, Foot B, Galloway J. et al. The Royal College of Ophthalmologists recommendations on screening for hydroxychloroquine and chloroquine users in the United Kingdom: executive summary. Eye (Lond) 2018; 32: 1168-1173 doi:10.1038/s41433-018-0136-x