Retinal Toxicity in Patients Treated With Hydroxychloroquine: A Cross-Sectional Study
Medical hypothesis discovery and innovation in ophthalmology,
Vol. 5 No. 2 (2016),
1 June 2016
,
Page 41-46
Abstract
Hydroxychloroquine (HCQ) is an antimalarial medication that can also be used to treat autoimmune diseases. However, it can produce irreversible changes to the retina that lead to visual impairment. The aim of this study was to determine the proportion of patients treated with HCQ who develop retinal toxicity and the risk factors for the development of HCQ-induced retinal toxicity among Iranian patients. The is a cross-sectional clinical study of 59 patients who were treated with HCQ during 2014–2015. A questionnaire was used to collect data on the following demographic and clinical factors: age, gender, type of rheumatic disease, history of cataract surgery, daily and cumulative HCQ dose, and duration of HCQ use. Retinal toxicity was diagnosed on the basis of the automated perimetry results of the central 10° of vision and spectral domain optical coherence tomography. The associations between the demographic and clinical factors and retinal toxicity were assessed, and P < 0.05 was considered statistically significant. Retinal toxicity was detected in 18 (30.5%) of the patients, and 5 (8.5 %) developed color vision impairments. There was no association between retinal toxicity and sex (P = 0.514), history of cataract surgery (P = 0.479), type of rheumatic disease (P = 0.539), or daily HCQ dose (P = 0.062). However, there was a significant positive association between retinal toxicity and age (P = 0.006), cumulative HCQ dose (P = 0.002), and duration of HCQ use (P < 0.001). In conclusion, the risk factors for retinal toxicity after HCQ treatment were advanced age, use of a higher cumulative HCQ dose, and a longer duration of treatment.ÂReferences
Stelton CR, Connors DB, Walia SS, Walia HS. Hydrochloroquine retinopathy: characteristic presentation with review of screening. Clin Rheumatol. 2013;32(6):895-8. PMID: 23515601
Felson DT, Anderson JJ, Meenan RF. The comparative efficacy and toxicity of second-line drugs in rheumatoid arthritis. Results of two metaanalyses. Arthritis Rheum. 1990;33(10):1449-61. PMID: 1977391
Szostakiewicz-Grabek B, Juszkiewicz-Borowiec M, Krasowska D. [The effect of drugs used in treatment of skin disorders on visual system]. Pol Merkur Lekarski. 2016;40(238):269-72. PMID: 27137831
Flach AJ. Improving the risk-benefit relationship and informed consent for patients treated with hydroxychloroquine. Trans Am Ophthalmol Soc. 2007;105:191-4; discussion 5-7. PMID: 18427609
Marmor MF, Kellner U, Lai TY, Lyons JS, Mieler WF, American Academy of O. Revised recommendations on screening for chloroquine and hydroxychloroquine retinopathy. Ophthalmology. 2011;118(2):415-22. PMID: 21292109
Wallace DJ. Advances in drug therapy for systemic lupus erythematosus. BMC Med. 2010;8:77. PMID: 21114845
Palma Sanchez D, Rubio Velazquez E, Soro Marin S, Reyes Garcia R. Retinal toxicity due to antimalarials: frequency and risk factors. Reumatol Clin. 2013;9(5):259-62. PMID: 23707434
Mobini M, Ahmadzadeh-Amiri A, Khani S. Hydroxychloroquine Induced Retinopathy: A Case Series. Iran J Health Sci. 2016;4(3):45-53.
Motarjemizadeh Q, Aidenloo NS, Abbaszadeh M. Detection of Hydroxychloroquine Retinal Toxicity by Automated Perimetry in 60 Rheumatoid Arthritis Patients with Normal Fundoscopic Findings. Glob J Health Sci. 2015;8(3):59-64. PMID: 26493438
Browning DJ, Lee C. Scotoma analysis of 10-2 visual field testing with a red target in screening for hydroxychloroquine retinopathy. Clin Ophthalmol. 2015;9:1499-509. PMID: 26316692
Browning DJ, Lee C. Scotoma analysis of 10-2 visual field testing with a white target in screening for hydroxychloroquine retinopathy. Clin Ophthalmol. 2015;9:943-52. PMID: 26060390
Lee AG. Hydroxychloroquine screening. Br J Ophthalmol. 2005;89(5):521-2. PMID: 15834072
Farrell DF. Retinal toxicity to antimalarial drugs: chloroquine and hydroxychloroquine: a neurophysiologic study. Clin Ophthalmol. 2012;6:377-83. PMID: 22457587
Grondahl J. Estimation of prognosis and prevalence of retinitis pigmentosa and Usher syndrome in Norway. Clin Genet. 1987;31(4):255-64. PMID: 3594933
Sen P, Bhargava A, George R, Ve Ramesh S, Hemamalini A, Prema R, et al. Prevalence of retinitis pigmentosa in South Indian population aged above 40 years. Ophthalmic Epidemiol. 2008;15(4):279-81. PMID: 18780262
Wolfe F, Marmor MF. Rates and predictors of hydroxychloroquine retinal toxicity in patients with rheumatoid arthritis and systemic lupus erythematosus. Arthritis Care Res (Hoboken). 2010;62(6):775-84. PMID: 20535788
Melles RB, Marmor MF. The risk of toxic retinopathy in patients on long-term hydroxychloroquine therapy. JAMA Ophthalmol. 2014;132(12):1453-60. PMID: 25275721
Pasadhika S, Fishman GA, Choi D, Shahidi M. Selective thinning of the perifoveal inner retina as an early sign of hydroxychloroquine retinal toxicity. Eye (Lond). 2010;24(5):756-62; quiz 63. PMID: 20395978
Pasadhika S, Fishman GA. Effects of chronic exposure to hydroxychloroquine or chloroquine on inner retinal structures. Eye (Lond). 2010;24(2):340-6. PMID: 19373270
Duncker G, Bredehorn T. Chloroquine-induced lipidosis in the rat retina: functional and morphological changes after withdrawal of the drug. Graefes Arch Clin Exp Ophthalmol. 1996;234(6):378-81. PMID: 8738704
Hallberg A, Naeser P, Andersson A. Effects of long-term chloroquine exposure on the phospholipid metabolism in retina and pigment epithelium of the mouse. Acta Ophthalmol (Copenh). 1990;68(2):125-30. PMID: 2356698
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