Pericentral Hydroxychloroquine Retinopathy in Korean Patients

Lee, Dong Hoon; Melles, Ronald B.; Joe, Soo Geun; Lee, Joo Yong; Kim, June-Gone; Lee, Chang‐Keun; Yoo, Bin; Koo, Bon San; Kim, Jee Taek; Marmor, Michael F.; Yoon, Young Hee

doi:10.1016/j.ophtha.2015.01.014

Cited by 80 publications

(65 citation statements)

References 18 publications

(16 reference statements)

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“…We only included structural and functional characterization related to the central macular area, because there is a general consensus that the retinal effects of hydroxychloroquine are mainly targeted at the parafovea [1, 4]. However, this might not be true for all patients, particularly Asians who have a more pericentral retinopathy [20, 21]. Because our cohort consisted of a very homogeneous sample of Caucasian patients of European descent, in which this more peripheral phenotype has only been documented in 2% of cases [20], we believe that only considering the paracentral drug-induced changes is not a significant bias.…”

Section: Discussionmentioning

confidence: 99%

Structural and Functional Characterization of the Retinal Effects of Hydroxychloroquine Treatment in Healthy Eyes

et al. 2019

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Purpose: To evaluate the influence of hydroxychloroquine in visual field and retinal layer thickness. Methods: This is a retrospective cross-sectional study. Patients taking hydroxychloroquine without signs of hydroxychloroquine retinopathy were included. Optical coherence tomography segmentation was used to obtain the ETDRS map thickness of each retinal layer. Groups were divided into short-term (< 5 years) and long-term (≥5 years) drug use. Results: We included 93 eyes of 93 patients (short-term: 25 eyes; long-term: 68 eyes). The inner nuclear layer (INL) was thinner in the long-term group (32.86 ± 2.12 vs. 34.14 ± 2.37 μm; p = 0.014). Considering long-term cases, the parafoveal ganglion cell layer (GCL) showed an inverse correlation with cumulative dose (r = –0.37; p < 0.001). After adjusting for confounders, parafoveal ganglion cell complex thickness was associated with cumulative dose (β = –0.239; p = 0.011). The parafoveal outer retina and visual field indices were similar between groups and did not correlate with cumulative dose. Conclusion: Hydroxychloroquine leads to progressive thinning of the parafoveal inner retina, particularly the INL and GCL. Visual field indices do not reflect the long-term effects of the drug.

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Section: Discussionmentioning

confidence: 99%

Structural and Functional Characterization of the Retinal Effects of Hydroxychloroquine Treatment in Healthy Eyes

et al. 2019

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“…10 Asian patients demonstrate a pericentral pattern of disease, and wider field imaging and visual field testing (30-2) may be required in these patients. 11,12 Rheumatologists, Ophthalmologists and General practitioners who are involved in the care of these patients need to be aware of the need for initial screening and regular monitoring of patients. These cases highlight the importance of recognising and managing this emerging problem.…”

Section: Eyementioning

confidence: 99%

Hydroxychloroquine retinopathy: an emerging problem

Latasiewicz

Gourier

Yusuf

et al. 2017

Eye

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PurposeThe aim of this case series is to raise awareness of the emerging issue of serious retinal damage caused by the prolonged use of hydroxychloroquine (HCQ) and the importance of adequate and appropriate monitoring of visual function during treatment.Patient and methodsThis is a small retrospective case series of 3 patients on long-term HCQ who developed serious symptomatic retinal toxicity confirmed on imaging and functional testing.ResultsAll 3 patients were treated with HCQ for over 15 years; two for rheumatoid arthritis (RA), and the third for systemic lupus erythematosus (SLE). All 3 patients had macular involvement varying in severity confirmed with characteristic features on imaging and functional testing (Optical Coherence Tomography (OCT), Autofluorescence (AF) and Humphrey 10-2 visual fields).ConclusionHCQ is widely used to treat autoimmune conditions with a proven survival benefit in patients with SLE. However, long-term use can be associated with irreversible retinal toxicity. These cases highlight that HCQ, like chloroquine, can also cause visual loss in susceptible individuals. Early detection of presymptomatic retinal changes by the introduction of appropriate screening and monitoring is mandatory to limit the extent of irreversible visual loss due to HCQ retinal toxicity.

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“…HCQ retinopathy presents with initial photoreceptor damage in a classic parafoveal distribution, known as a “bull’s eye” pattern, which corresponds to parafoveal scotomas upon visual field examination [8, 9] and parafoveal thinning of the outer nuclear layer with breakup of the ellipsoid zone and interdigitation zone lines on SD-OCT. [10] However, recent studies have shown that the initial pattern of damage in Asian eyes is more frequently in the more peripheral extramacular area near the arcades, as a pericentral pattern [11, 12]. In this pattern of retinopathy, CME may threaten relatively preserved central vision, leading to deterioration of visual function.…”

Section: Discussionmentioning

confidence: 99%

The effect of oral acetazolamide on cystoid macular edema in hydroxychloroquine retinopathy: a case report

et al. 2017

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BackgroundHydroxychloroquine (HCQ) retinopathy can accompany other retinal complications such as cystoid macular edema (CME), which leads to central visual loss. We report a case of CME with HCQ retinopathy that improved with the use of oral acetazolamide, and discussed the possible mechanisms of CME in HCQ retinopathy using multimodal imaging modalities.Case presentationA 62-year-old patient with systemic lupus erythematosus (SLE) and HCQ retinopathy developed bilateral CME with visual decline. Fluorescein angiography (FA) showed fluorescein leakage in the macular and midperipheral area. After treatment with oral acetazolamide (250 mg/day) for one month, CME was completely resolved, best corrected visual acuity (BCVA) improved from 20/50 to 20/25, and FA examination showed decreased dye leakage in the macular and midperipheral areas.ConclusionsIn cases of vision loss in HCQ retinopathy, it is important to consider not only progression of maculopathy, but also development of CME, which can be effectively treated with oral acetazolamide.

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Pericentral Hydroxychloroquine Retinopathy in Korean Patients

Cited by 80 publications

References 18 publications

Structural and Functional Characterization of the Retinal Effects of Hydroxychloroquine Treatment in Healthy Eyes

Structural and Functional Characterization of the Retinal Effects of Hydroxychloroquine Treatment in Healthy Eyes

Hydroxychloroquine retinopathy: an emerging problem

The effect of oral acetazolamide on cystoid macular edema in hydroxychloroquine retinopathy: a case report

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