Frequency and risk factors for hydroxychloroquine retinopathy among patients with systemic lupus erythematosus

Abstract

Background Hydroxychloroquine (HCQ) is an antimalarial drug, recently used in COVID-19 treatment. Also it is considered over many years the cornerstone in treating systemic lupus erythematosus (SLE) in adults and children. The incidence of retinal affection and retinal toxicity from hydroxychloroquine is rare, but even after the HCQ is stopped, loss of vision may not be reversible and may continue to progress. Fundus autofluorescence (FAF) is one of the screening methods recommended by AAO used for the diagnosis of hydroxychloroquine retinopathy. Our aim is to detect early HCQ-induced retinopathy among SLE patients and the risk factors for its development by using fundus autofluorescence. Results In the present study, 11.3% of the studied patients had significant visual field changes upon testing. Of those, 6.3% had abnormal fundus autofluorescence. We found a significant statistical relation between hydroxychloroquine retinopathy and the duration and cumulative dose of hydroxychloroquine therapy (p value = 0.003) and decreased best-corrected visual acuity of both eyes (p value = 0.000). There was no relationship between HCQ retinopathy detected by fundus autofluorescence and daily dose of HCQ/kg, age, sex, and SLEDAI score. Conclusion Frequency of SLE patients who had confirmed HCQ-induced retinopathy was 6.3%. Hydroxychloroquine could be safely used in all SLE patients regardless of age, sex, and SLE activity. Routine ophthalmological assessment is recommended for SLE patients who received HCQ especially for those who received HCQ longer than 7 years. Fundus autofluorescence is a modern objective tool which is specific for the early detection of HCQ retinopathy.

Use of optical coherence tomography retinal thickness deviation map for hydroxychloroquine retinopathy screening

“…12 In our study, the male-to-female ratio was 1:2 in group 2 (P<0.03), similar to Melles et al, who found that the retinal toxicity was higher in females (P=0.08); 7 whereas Abdelbaky et al, observed no relationship between HCQS retinopathy and gender (P=0.003). 13 In our study of HCQS, retinopathy was slightly higher (P<0.01) in low socioeconomic status group patients, similar to Pinto et al, 14 whereas Yusuf et al, found that higher dose, long duration, and renal impairment as risk factors. 15 In our study, there is a significant relation between diabetes mellitus, renal impairment, RA factor, and ANA and HCQS retinopathy (P<0.05), similar to Anderson et al 16 Tangtavoran et al, observed no direct relation between RA factor, ANA, and renal disease with HCQS retinopathy (P<0.05).…”

Trends and practices following the 2016 hydroxychloroquine screening guidelines

“…Other indications for HCQ use were also seen in our study, which comprised 30.7% (51/166) of our cohort. Several researchers investigated screening and retinal toxicity identified in patients with SLE and RA 2 , 5 , 16 , 23 – 27 . However, screening for HCQ retinopathy from indications other than SLE and RA has not been carefully studied.…”