Delayed progression of bull’s eye maculopathy

Jain, Sunila; Jain, Nikhil

doi:10.1136/bcr-2017-220598

Cited by 5 publications

(4 citation statements)

References 8 publications

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“…In this 1-year follow-up, a slight increase of the atrophic area was found for patients with BEM even after cessation of drug intake, suggestive for disease progression, and in line with previous reports. 41 – 44 A possible reason could be the long half-life period of CQ/HCQ metabolites in retinal tissue. 45 …”

Section: Discussionmentioning

confidence: 99%

Quantitative Fundus Autofluorescence in Systemic Chloroquine/Hydroxychloroquine Therapy: One Year Follow-Up

Radun

Berlin

Tarau

et al. 2023

Trans. Vis. Sci. Tech.

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Purpose Systemic chloroquine/hydroxychloroquine (CQ/HCQ) can cause severe ocular side effects including bull's eye maculopathy (BEM). Recently, we reported higher quantitative autofluorescence (QAF) levels in patients with CQ/HCQ intake. Here, QAF in patients taking CQ/HCQ in a 1-year follow-up is reported. Methods Fifty-eight patients currently or previously treated with CQ/HCQ (cumulative doses 94-2435 g) and 32 age- and sex-matched healthy subjects underwent multimodal retinal imaging (infrared, red free, fundus autofluorescence [FAF], QAF [488 nm], and spectral-domain optical coherence tomography (SD-OCT). For analysis, custom written FIJI plugins were used for image processing, multimodal image stacks assembling, and QAF calculation. Results Thirty patients (28 without BEM and 2 with BEM, age range = 25–69 years) were followed up (370 ± 63 days). QAF values in patients taking CQ/HCQ showed a significant increase between baseline and follow-up examination: 282.0 ± 67.9 to 297.7 ± 70.0 (QAF a.u.), P = 0.002. An increase up to 10% was observed in the superior macular hemisphere. Eight individuals (including 1 patient with BEM) had a pronounced QAF increase of up to 25%. Compared to healthy controls, QAF levels in patients taking CQ/HCQ were significantly increased ( P = 0.04). Conclusions Our study confirms our previous finding of increased QAF in patients taking CQ/HCQ with a further significant QAF increase from baseline to follow-up. Whether pronounced QAF increase might predispose for rapid progression toward structural changes and BEM development is currently investigated in ongoing studies. Translational Relevance In addition to standard screening tools during systemic CQ/HCQ treatment, QAF imaging might be useful in CQ/HCQ monitoring and could serve as a screening tool in the future.

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Section: Discussionmentioning

confidence: 99%

Quantitative Fundus Autofluorescence in Systemic Chloroquine/Hydroxychloroquine Therapy: One Year Follow-Up

Radun

Berlin

Tarau

et al. 2023

Trans. Vis. Sci. Tech.

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“…Five of these patients exceeded a cumulative dose of 1000 g, as they surpassed a duration of 5 years. Sudden deterioration of vision and development of bull’s eye maculopathy were reported in patients who received a maintenance dose as low as 200 mg for more than ten years [ 19 , 20 ], as well in cases with shorter duration of use [ 21 , 22 , 23 ]. In this study, one patient with SS reported retinal toxicity within three years of the therapy but received a high dose of HCQ.…”

Section: Discussionmentioning

confidence: 99%

Knowledge of Saudi Patients with Autoimmune Diseases about Hydroxychloroquine Toxicity: The Role of Physician–Patient Communication

et al. 2022

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This cross-sectional internet-based questionnaire aimed to assess the knowledge and experience of autoimmune disease patients in Saudi Arabia of the ocular effects of hydroxychloroquine (HCQ). Among the 245 respondents, discontinuation of the drug was linked to its ocular toxicity in approximately 7.3%. Most patients had taken HCQ for a period longer than five years, exceeding a dose of 5 mg/Kg. A lack of education and physician communication about medication toxicity was reported by approximately 40.8% of the participants. Despite the knowledge about HCQ retinopathy, the drug is prescribed to autoimmune disease patients at an inappropriate dosage. Knowledge obtained from physicians’ communication may improve the health outcomes of chronically ill patients. Rheumatologists and ophthalmologists should work together to recognize patients at risk of hydroxychloroquine toxicity and ensure they receive proper education and adhere to periodic follow-up.

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“…Treatment for HCQ toxicity involves cessation of the drug and monitoring for further progression of retinal damage. The prognosis for patients with bull’s eye maculopathy due to HCQ toxicity is variable, with some patients experiencing improvement in visual function after cessation of the drug, while others may experience permanent vision loss[ 20 - 22 ]. In some cases, the damage caused by the drug may be delayed and irreversible, resulting in permanent vision loss.…”

Section: To the Editormentioning

confidence: 99%

“…In some cases, the damage caused by the drug may be delayed and irreversible, resulting in permanent vision loss. There are currently no Food and Drug Administration-approved treatments for bull’s eye maculopathy due to HCQ toxicity[ 22 ].…”

Section: To the Editormentioning

confidence: 99%

Ophthalmologic implications to consider when using hydroxychloroquine to treat COVID-19 and induced arthritis

Zeppieri

2023

World J Exp Med

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Orphan diseases are rare diseases that affect less than 200000 individuals within the United States. Most orphan diseases are of neurologic and genetic origin. With the current advances in technology, more funding has been devoted to developing therapeutic agents for patients with these conditions. In our review, we highlight emerging options for patients with neurologic orphan diseases, specifically including diseases resulting in muscular deterioration, epilepsy, seizures, neurodegenerative movement disorders, inhibited cognitive development, neuron deterioration, and tumors. After extensive literature review, gene therapy offers a promising route for the treatment of neurologic orphan diseases. The use of clustered regularly interspaced palindromic repeats/Cas9 has demonstrated positive results in experiments investigating its role in several diseases. Additionally, the use of adeno-associated viral vectors has shown improvement in survival, motor function, and developmental milestones, while also demonstrating reversal of sensory ataxia and cardiomyopathy in Friedreich ataxia patients. Antisense oligonucleotides have also been used in some neurologic orphan diseases with positive outcomes. Mammalian target of rapamycin inhibitors are currently being investigated and have reduced abnormal cell growth, proliferation, and angiogenesis. Emerging innovations and the role of genetic treatments open a new window of opportunity for the treatment of neurologic orphan diseases.

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Delayed progression of bull’s eye maculopathy

Cited by 5 publications

References 8 publications

Quantitative Fundus Autofluorescence in Systemic Chloroquine/Hydroxychloroquine Therapy: One Year Follow-Up

Quantitative Fundus Autofluorescence in Systemic Chloroquine/Hydroxychloroquine Therapy: One Year Follow-Up

Knowledge of Saudi Patients with Autoimmune Diseases about Hydroxychloroquine Toxicity: The Role of Physician–Patient Communication

Ophthalmologic implications to consider when using hydroxychloroquine to treat COVID-19 and induced arthritis

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