Recommendations on screening for chloroquine and hydroxychloroquine retinopathy

Mitochondrial membrane permeabilization is a critical step of lysosome-initiated apoptosis induced by hydroxychloroquine

“…To address this issue, we took advantage of the lysosomotropic amine hydroxychloroquine, which is clinically used for the treatment of malaria, rheumatoid arthritis, and systemic lupus erythematosus. As do other immunosuppressive drugs, this agent exerts potent cytotoxic effects (Lai et al, 2001), which in part may explain unwarranted effects on the nervous system and the retina (Zaidi et al, 2001;Marmor et al, 2002). Here we report that hydroxychloroquine (HCQ) induces cell death apoptosis through a lysosomal mechanism.…”

Dosage of hydroxychloroquine should be based on ideal body weight: Comment on the letter by Alarcón

“…More recently, Dr. Blomquist alerted me to the fact that the American Academy of Ophthalmology had just released their updated recommendations on screening for antimalarial retinopathy (2). According to these recommendations, all patients who receive antimalarials should have a complete baseline ophthalmologic evaluation, but the frequency of subsequent assessments should be based on whether the patient is considered at high risk or at low risk of developing retinopathy.…”

“…According to these recommendations, all patients who receive antimalarials should have a complete baseline ophthalmologic evaluation, but the frequency of subsequent assessments should be based on whether the patient is considered at high risk or at low risk of developing retinopathy. Such a distinction between high-risk and low-risk patients is based on the following factors: dose, duration of use, body habitus, presence of renal/liver involvement, presence of concomitant retinal disease, and age (2). Had I used the Academy's recent recommendations, my patient would have been considered as being at relatively low risk for retinal toxicity, and the complication would not have been detected by screening for several more months (when visual changes would have become overt).…”

Fatores de risco e métodos diagnósticos para retinopatia por difosfato de cloroquina nos portadores de lúpus eritematoso sistêmico

“…Foi sugerida a classificação dos pacientes de acordo com o risco de desenvolverem a retinopatia 60 . Inicialmente, a retinopatia foi associada ao uso crônico e a altas doses cumulativas 44 ou a altas doses diárias da droga 45 .…”

“…De acordo com a Academia Americana de Oftalmologia (AAO), o alto risco de desenvolver a retinopatia tem relação com doses diárias acima de 3,0 mg/kg/dia, alta taxa de gordura corporal e tempo de uso maior que cinco anos 60 A autofluorescência nos comprimentos de onda próximos ao infravermelho, que apresentam excitação com 787 nm e emissão com mais de 800 nm, está relacionada à concentração de melanina 69 . Do mesmo modo que na AFF, a diminuição da autofluorescência indica perda de células do EPR 69 .…”