Assessment of hydroxychloroquine maculopathy after cessation of treatment: an optical coherence tomography and multifocal electroretinography study

Abstract

ObjectiveThis study was conducted to evaluate the macular status of patients treated with hydroxychloroquine before and after cessation of treatment.MethodsForty-two patients with systemic lupus erythematosus underwent ocular examination based on visual acuity evaluation, optical coherence tomography retinal thickness measurements, and multifocal electroretinography (mfERG) records at first visit. The tests were repeated 6 months after treatment withdrawal and compared to the findings at their first visit.ResultsMean visual acuity (measured in log minimum angle of resolution) of both eyes was statistically increased after hydroxychloroquine discontinuation (difference in means: 0.06 [P<0.0001] and 0.01 [P=0.003] for the right and left eyes, respectively). Retinal response amplitudes of central and peripheral areas were significantly improved for both eyes. The following values were observed for central responses: the difference in means was −19.9 (P<0.0001) and −13.6 (P<0.0001) for the right eye and the left eye, respectively; for peripheral responses, difference in means was −10.3 (P<0.0001) and −9.5 (P<0.0001) for right eye and left eye, respectively, after the 6-month examination. There were no statistically significant differences in the retinal thickness of patients after cessation of treatment. The visual acuity of the patients was correlated to central and peripheral mfERG responses (r=−0.53 [P<0.0001] and r=−0.53 [P<0.0001], for the right eye and the left eye, respectively).ConclusionThe visual acuity of patients receiving hydroxychloroquine improves along with the amplitudes of the mfERG responses 6 months after discontinuation of the drug, but no difference in retinal thickness is identified.

Hydroxychloroquine for treatment of rheumatoid arthritis: multifocal electroretinogram and laser flare-cell photometry study

“…These data are consistent with previous reports in the literature,24,27,28 and only one study found an increased latency without reduction in amplitude 29…”

Latent orbital pseudotumor secondary to systemic lupus erythematosus

“…Retinopathy and maculopathy are widely known complications of hydroxychloroquine treatment, although inflammatory pseudotumor has never been described in this setting. Although visual loss may be irreversible and even worsen after suspending treatment with hydroxychloroquine, this is more likely if high doses of hydroxychloroquine are used for more than 5 years or if there is impaired renal or liver function . Although our patient had been treated with hydroxychloroquine for 10 years, the daily doses were below 6, 5 mg/kg, which are associated with very low risk of retinopathy.…”

Hydroxychloroquine retinopathy

“…25,59 One longitudinal study evaluated visual acuity, SD-OCT imaging data and mfERG of patients on HCQ, and 6 months following drug cessation finding improved visual acuity and mfERG responses, but not OCT appearances. 61 A further study evaluating only SD-OCT imaging characteristics before and for 4 years after drug cessation in 11 patients with HCQ retinopathy found that if HCQ is stopped before RPE damage, progression of disease on SD-OCT is limited to the first year and diffuse in distribution without parafoveal localisation. 39 There is some evidence that preservation of the external limiting membrane is a favourable prognostic sign in HCQ retinopathy.…”

“…60 One study identified improvement of visual function in HCQ retinopathy following drug cessation, but no improvement in structural parameters. 61 A key recent finding was the identification of variable distributions of disease in HCQ/CQ retinopathy on the basis of race. 62 Patients of European descent exhibit a classic parafoveal pattern (2-6 degrees from the fovea) of structural and functional deficits, were more likely to manifest an extramacular or pericentral (more than 8 degrees from the fovea) pattern of disease in the early stages with structural and functional abnormalities identified near the vascular arcades.…”