Hydroxychloroquine and visual screening in a rheumatology outpatient clinic

Abstract

Objective-To review 10 years' data relating to visual screening of patients taking hydroxychloroquine. Methods-Following baseline visual assessment, ophthalmic monitoring was carried out at six monthly intervals on 758 patients while on hydroxychloroquine. This consisted of corrected visual acuity, central field screening with a red Amsler grid, slit lamp examination, and retinoscopy. Results-None of the patients suVered visual impairment from retinal toxicity, though 12 reported visual disturbance. This was related to ocular muscle imbalance in four. In the remainder, none of the ocular findings was directly attributable to hydroxychloroquine. Ten patients reported defects when tested with a red Amsler grid. None was related to retinal toxicity. Seven patients developed corneal drug deposits which cleared on stopping or reducing the dose of hydroxychloroquine. Conclusions-The findings support the view that following baseline ophthalmic examination for patients receiving hydroxychloroquine, regular ophthalmic screening is not required if the daily dose is less than 6.5 mg kg -1 and the cumulative dose is less than 200 g.

Therapy and pharmacological properties of hydroxychloroquine and chloroquine in treatment of systemic lupus erythematosus, rheumatoid arthritis and related diseases

“…This is because the retinopathy leads to vision loss, and frequently is irreversible even after discontinuing the drug and in some cases can even progress, long after the medication has been discontinued (Wei et al 2001). Previous studies have shown that the retinal toxicity is directly related to the total dose of drug exposure and the current recommendations are to keep the daily dose of HCQ to 6 mg/kilogram body weight and chloroquine to 4 mg/kilogram body weight, or less, if at all possible [Marmor et al 2002) and the total drug dosage to less than 200 g (Grierson 1997). Patients are recommended to get eye examinations, with visual fields' examination every 6 months (Marmor et al 2002;Easterbrook 2002).…”

Cutaneous sarcoidosis therapy updated

“…32,34 Although hydroxychloroquine allegedly has a lower risk of ocular toxicity than chloroquine, maculopathy has been reported, and patients receiving this antimalarial agent should be followed in the same fashion as those receiving chloroquine. 35,36 Because rare cases of delayed antimalarial retinopathy have been reported, patients should be followed by an ophthalmologist during and for several years after treatment. 30 Significant hepatic toxicity is atypical, and liver function may be monitored every 6 to 12 months.…”

Tela de Amsler e campo visual no rastreamento da retinopatia por cloroquina

“…O teste de sensibilidade ao contraste (6,18) pode ser útil na detecção precoce. Recente revisão das recomendações da Academia Americana de Oftalmologia aponta para o rastreamento com novas tecnologias, quando acessíveis ao médico, tais como OCT de alta resolução, autofluorescência retiniana e ERG multifocal, pois parecem ser mais precoces que os exames pe rimétricos (5,6,15,19) .…”

“…O mesmo artigo condena o uso do Amsler, uma vez que despende muita atenção para uma leitura correta, mas já há controvérsias (20) . Há autores que defendem a falta de necessidade de acompanhamento (18,21,22) , mas novos casos não publicados em todo o mundo apontam para a importância do diagnóstico precoce (23) . Este estudo teve por objetivos comparar as alterações da tela de Amsler modificada às alterações do CV nos usuários de DFC, para avaliar o melhor método de detecção da maculopatia precoce (re tinopatia inicial medicamentosa em pacientes que ainda não apresentam alterações fundoscópicas) e correlacionar as variáveis idade, tem po de uso do fármaco, dose diária, dose cumulativa e acuidade visual com os exames normais e alterados.…”