Hydroxychloroquine retinopathy: an emerging problem

Abstract

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.

Are techniques for general anesthesia less invasive than procedures for cataract surgery?

“…We agreed with the conclusions of Latasiewicz et al 1 'Hydroxychloroquine retinopathy: an emerging problem', which cited cases of hydroxychloroquine (HCQ)-induced retinal damage. Three patients had received 400 mg HCQ daily for over 15 years (equaling 4.93 mg/kg/day in two and 5.6 mg/kg/day in one) and all developed maculopathies of varying severity.…”

“…Ocular toxicity ranged from non-significant keratopathy to a potentially blinding retinopathy as described previously with varying doses of HCQ. 1,2 In 2016 the American Academy of Ophthalmology recommended a maximum daily HCQ use of 5.0 mg/kg, a baseline fundal examination to exclude pre-existing maculopathy and an annual screening after 5 years of HCQ use. 3 Being a synthetic antimalarial, HCQ is used for immunomodulation in autoimmune diseases.…”

“…The authors declare no conflict of interest. 1 Corneal crystalline deposition is a rarely reported but known ocular manifestation of MM. 2 Recent reports have employed in vivo confocal microscopy (IVCM) to investigate MM-associated crystalline deposits.…”

The Royal College of Ophthalmologists recommendations on screening for hydroxychloroquine and chloroquine users in the United Kingdom: executive summary

“…Such tests are generally acceptable to patients. Some ophthalmologists have recognised an increasing number of patients diagnosed with advanced hydroxychloroquine retinopathy who have developed symptoms [8]. It is also recognised that some opportunistic screening takes place in the hospital eye service led by clinicians in patients considered at risk of toxicity and in some motivated patients who seek referral for screening.…”

How to set up a Hydroxychloroquine Retinopathy Screening Service

“…Early UK data is cited herein. Ophthalmologists are highlighting the need for greater awareness of these risks, and cases of missed retinopathy are appearing in the courts [3][4][5][6][7].…”