Complicações oculares da terapêutica com a cloroquina e derivados

Lacava, Augusto Cézar

doi:10.1590/s0004-27492010000400019

“…Some articles consider cumulative dose as the most important risk factor. A daily dose of CQ greater than 250 mg/day or greater than 4 mg/kg/day and of HCQ greater than 400 mg/day or greater than 6.5 mg/kg/day translates to an accumulated risk greater than 460 g for CQ and greater than 1000 g for HCQ (2,3,5,8,(14)(15)(16)(17)(18)(19) .…”

Section: Introductionmentioning

confidence: 99%

Evaluation of toxic retinopathy caused by antimalarial medications with spectral domain optical coherence tomography

Cabral¹,

Klumb²,

Couto³

et al. 2019

Arquivos Brasileiros De Oftalmologia

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| Purpose: To investigate the frequency of toxic retinopathy in patients with lupus erythematosus and rheumatoid arthritis with long-term use of chloroquine diphosphate or hydroxychloroquine through spectral domain optical coherence tomography and the outcomes of ophthalmological exams (visual acuity -Snellen's table, color vision test -Ishihara's table, fundoscopy, and retinography -red-free). Methods: A cross-sectional study was carried out involving the ophthalmologic evaluation of patients using regular chloroquine diphosphate or hydroxychloroquine for a period of 1 year or longer. The patients completed a questionnaire on their opinions and treatment regularity. The same patients underwent ophthalmologic examination and spectral domain optical coherence tomography. Results: The prevalence of toxic retinopathy caused by antimalarials was 4.15% (9 of 217 patients), 7.4% (4 of 54 patients) following chloroquine diphosphate usage, and 0.82% (1 of 121 patients) following hydroxychloroquine usage. Only patients with advanced stage maculopathy presented abnormalities during the ophthalmologic exam: the color vision test was altered in 11.1%, and visual acuity and fundoscopy were altered in 33.3%. Identification of early toxic retinopathy, detected in six patients, was possible using spectral domain optical coherence tomography. The mean duration of antimalarial drug usage among patients with toxic retinopathy was 10.4 years. Only 31% of the patients reported some symptoms during treatment, and although 24% were afraid to use the medication, they did so as prescribed. Conclusion: Use of spectral domain optical coherence tomography was essential for the diagnosis of early-stage antimalarial toxic retinopathy in patients with the following characteristics: asymptomatic, antimalarial use 7 days a week for a period of more than 5 years, and normal clinical ophthalmologic examination.Keywords: Retinopathy/etiology; Antimalarials/adverse effects; Hydroxychloroquine/adverse effects; Chloroquine/adverse effects; Tomography, optical coherence/methods RESUMO | Objetivo: Investigar a frequência da retinopatia tóxica em pacientes com lúpus eritematoso e artrite reumatóide com uso crônico de difosfato de cloroquina ou hidroxicloroquina, através de tomografia de coerência óptica de domínio espectral e os resultados dos exames oftalmológicos (acuidade visual -tabela de Snellen, teste de visão de cor -tabela de Ishihara, fundoscopia e retinografia -red free). Métodos: Foi realizado um estudo transversal envolvendo a avaliação oftalmológica de pacientes em uso regular de difosfato de cloroquina ou hidroxicloroquina por um período de um ano ou mais. Os pacientes responderam a um questionário sobre a sua opinião e regularidade do tratamento. Os mesmos pacientes realizaram exame oftalmológico clínico e tomografia de coerência óptica de domínio espectral. Resultados: A prevalência de retinopatia tóxica por antimaláricos foi de 4,15% (9 dos 217 pacientes), 7,4% (4 de 54 pacientes) após uso de difosfato de cloroquina e 0,82% (1 de 121 pac...

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“…Both drugs are recommended for the treatment of RA and LE. However, HCQ is described as having less toxicity, and therefore, it is more often prescribed (9,11,13,16,17) . The main reason for discontinuation of treatment, reported by a little more than a third of the patients, was ophthalmological complications.…”

Section: Discussionmentioning

confidence: 99%

“…Some articles consider cumulative dose as the most important risk factor. A daily dose of CQ greater than 250 mg/day or greater than 4 mg/kg/day and of HCQ greater than 400 mg/day or greater than 6.5 mg/kg/day translates to an accumulated risk greater than 460 g for CQ and greater than 1000 g for HCQ (2,3,5,8,(14)(15)(16)(17)(18)(19) .…”

Section: Introductionmentioning

confidence: 99%

Effects of topical azithromycin, moxifloxacin, and povidone iodine on conjunctival bacterial flora in patients undergoing intravitreal injection

Teberik¹,

Eski²,

Çalışkan³

et al. 2019

Arquivos Brasileiros De Oftalmologia

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| Purpose: To investigate the frequency of toxic retinopathy in patients with lupus erythematosus and rheumatoid arthritis with long-term use of chloroquine diphosphate or hydroxychloroquine through spectral domain optical coherence tomography and the outcomes of ophthalmological exams (visual acuity -Snellen's table, color vision test -Ishihara's table, fundoscopy, and retinography -red-free). Methods: A cross-sectional study was carried out involving the ophthalmologic evaluation of patients using regular chloroquine diphosphate or hydroxychloroquine for a period of 1 year or longer. The patients completed a questionnaire on their opinions and treatment regularity. The same patients underwent ophthalmologic examination and spectral domain optical coherence tomography. Results: The prevalence of toxic retinopathy caused by antimalarials was 4.15% (9 of 217 patients), 7.4% (4 of 54 patients) following chloroquine diphosphate usage, and 0.82% (1 of 121 patients) following hydroxychloroquine usage. Only patients with advanced stage maculopathy presented abnormalities during the ophthalmologic exam: the color vision test was altered in 11.1%, and visual acuity and fundoscopy were altered in 33.3%. Identification of early toxic retinopathy, detected in six patients, was possible using spectral domain optical coherence tomography. The mean duration of antimalarial drug usage among patients with toxic retinopathy was 10.4 years. Only 31% of the patients reported some symptoms during treatment, and although 24% were afraid to use the medication, they did so as prescribed. Conclusion: Use of spectral domain optical coherence tomography was essential for the diagnosis of early-stage antimalarial toxic retinopathy in patients with the following characteristics: asymptomatic, antimalarial use 7 days a week for a period of more than 5 years, and normal clinical ophthalmologic examination.Keywords: Retinopathy/etiology; Antimalarials/adverse effects; Hydroxychloroquine/adverse effects; Chloroquine/adverse effects; Tomography, optical coherence/methods RESUMO | Objetivo: Investigar a frequência da retinopatia tóxica em pacientes com lúpus eritematoso e artrite reumatóide com uso crônico de difosfato de cloroquina ou hidroxicloroquina, através de tomografia de coerência óptica de domínio espectral e os resultados dos exames oftalmológicos (acuidade visual -tabela de Snellen, teste de visão de cor -tabela de Ishihara, fundoscopia e retinografia -red free). Métodos: Foi realizado um estudo transversal envolvendo a avaliação oftalmológica de pacientes em uso regular de difosfato de cloroquina ou hidroxicloroquina por um período de um ano ou mais. Os pacientes responderam a um questionário sobre a sua opinião e regularidade do tratamento. Os mesmos pacientes realizaram exame oftalmológico clínico e tomografia de coerência óptica de domínio espectral. Resultados: A prevalência de retinopatia tóxica por antimaláricos foi de 4,15% (9 dos 217 pacientes), 7,4% (4 de 54 pacientes) após uso de difosfato de cloroquina e 0,82% (1 de 121 pac...

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“…Although these drugs yield good therapeutic results, there are significant concerns regarding the ocular toxicity of these drugs, particularly chloroquine. Chronic use of these drugs can result in retinal degeneration [2,7,8] that can persist even after the medication has been discontinued [5,9]. The two most important irreversible ocular side effects of chloroquine are retinotoxicity and corneal deposits [8,9].…”

Section: Discussionmentioning

confidence: 99%

Palate Hyperpigmentation Caused by Prolonged Use of the Anti-Malarial Chloroquine

Filho

¹

,

Silva

²

,

Dourado

³

et al. 2011

Head and Neck Pathol

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The side-effects of many drugs manifest in the oral mucosa. The anti-malarial agent chloroquine diphosphate, which is also used to treat immunological, dermatological, and rheumatological disorders, usually causes pigmentary changes in the oral mucosa. This report presents a case of palate pigmentation related to the prolonged use of chloroquine diphosphate caused by the deposition of drug metabolites in the mucosa. Healthcare professionals must be aware of these drugs and their adverse effects in order to make the correct diagnosis, decide on the optimal treatment for the condition, or refer the patient to an appropriate specialist.

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Complicações oculares da terapêutica com a cloroquina e derivados

Cited by 25 publications

References 25 publications

Evaluation of toxic retinopathy caused by antimalarial medications with spectral domain optical coherence tomography

Evaluation of toxic retinopathy caused by antimalarial medications with spectral domain optical coherence tomography

Effects of topical azithromycin, moxifloxacin, and povidone iodine on conjunctival bacterial flora in patients undergoing intravitreal injection

Palate Hyperpigmentation Caused by Prolonged Use of the Anti-Malarial Chloroquine

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