Ocular flare-up in patients with systemic lupus erythematosus following discontinuation of hydroxychloroquine

Abstract

In this report, we describe two patients with systemic lupus erythematosus (SLE) who manifested with posterior segment flare-up approximately three months after cessation of hydroxychloroquine (HCQ). They were stable systemically with no history of hypertension or nephropathy at the time of referral. Our first patient presented with bilateral retinal vein occlusion, while evidence of choroidal involvement such as vascular leakage and wedge-shaped filling delay was present in indocyanine green angiography of both patients. HCQ is well known to have a role in the treatment of SLE for its immunomodulatory and antithrombotic effects. Although reports of systemic flare-up of SLE following HCQ cessation exist in the literature, this is the first report of ocular flare-up in such settings.

Unveiling Ocular Manifestations in Systemic Lupus Erythematosus

“…Moschos et al reported that visual acuity and mfERG scores improved in 42 SLE patients after the cessation of hydroxychloroquine therapy [199]. On the other hand, posterior segment flare-ups have been reported after stopping hydroxychloroquine [200]. Steroidal systemic drugs like prednisolone used in acute phases of the disease are often tapered off and substituted with an immunosuppressant depending on the presentation of the disease [93].…”