Document Type : Original Article
Authors
Associate Professor of Rheumatology, AJA University of medical sciences,Tehran, Iran
Abstract
Several studies have reported the possibility of ocular toxicity with the use of antimalarial drugs by patients with rheumatic diseases. Thus, the present study intended to investigate the prevalence of such toxicity in these patients and the feasibility of the regression of changes after medication discontinuation. The present retrospective study included the medical records of 598 patients with rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), and mixed connective tissue disorders (MCTDs) who took chloroquine (CQ) or hydroxychloroquine (HCQ) and underwent routine ophthalmologic examinations. Moreover, if a patient had any ocular abnormality reported by the examining ophthalmologist, he/she was referred to another ophthalmologist to confirm the primary findings. Also, the patients with abnormal ocular findings who discontinued the drugs were re-examined 12 months after the drug discontinuation to evaluate the rate of regression of the ocular changes. According to our findings, 81 out of 598 patients (13.6%) had ocular toxicity in routine ophthalmologic examinations. However, ocular changes were ruled out in 49 (8.2%) patients using a second examination by another ophthalmologist. Therefore, retinopathy was confirmed in 32 out of 598 (5.4%) cases. Moreover, the patients with eye complications were significantly older than those without ocular toxicity (P = 0.03), while no significant relationship was found between ocular toxicity and other variables. Finally, of 32 patients with ocular toxicity, 12 patients were re-examined 12 months after the drug discontinuation, revealing normal findings in 7 (58%) patients, while 5 (42%) had irreversible ocular abnormalities. According to our findings, the prevalence of HCQ- and CQ-induced retinopathy was quite considerable in patients receiving these drugs. Therefore, despite the current controversies, we recommend that all patients receiving antimalarial drugs undergo screening for ocular toxicity.
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- Rabin JC, Ramirez K.Hydroxychloroquine ocular toxicity. J Rheumatol 2019;46(12):1640- 1641. doi: 10.3899/jrheum.181375
- Yam JC, Kwok AK. Ocular toxicity of hydroxychloroquine. Hong Kong Med J 2006; 12(4):294-304.
- Mohapatra A, Gupta P, Ratra D. Accelerated hydroxychloroquine toxic retinopathy.Doc Ophthalmol 2023 Oct 3. doi: 10.1007/s10633- 023-09950-x.
- Johnson MW, Vine AK. Hydroxychloroquine therapy in massive total doses without retinal toxicity. Am J Ophthalmol 1987; 104(2):139- 44. doi: 10.1016/0002-9394(87)90005-5.
- Schwartzman S, Samson CM. Are the current recommendations for chloroquine and hydroxy[1]chloroquine screening appropriate? Rheum Dis Clin North Am 2019;45(3):359-367. doi: 10.1016/j.rdc.2019.04.008.
- Mavrikakis I, Sfikakis PP, Mavrikakis E, Rougas K, Nikolaou A, Kostopoulos C. et al. The incidence of irreversible retinal toxicity in patients treated with hydroxychloroquine: a reappraisal. Ophthalmology 2003; 110(7):1321- 6. doi: 10.1016/s0161-6420(03)00409-3.
- Uğurlu A, Aslanova M, Cebeci Z, Kır Mercül N. Evaluation of Maculopathy in Patients Using Hydroxychloroquine. Turk J Ophthalmol 2019; 49(3):149-153. doi: 10.4274/tjo .
- Islam YFK, Stroman WR, Steigleman WA. Compliance with hydroxychloroquine screening guidelines at a large academic medical center. J Vitreoretin Dis 2022;6(4):271-277. doi: 10. 1177/24741264221097806 .
- Tehrani R, Ostrowski RA, Hariman R, Jay WM. Ocular toxicity of hydroxychloroquine. Semin Ophthalmol 2008; 23(3):201-9. doi: 10.1080/ 08820530802049962.
- Martínez-Costa L, Victoria Ibañez M, Murcia[1]Bello C, Epifanio I, Verdejo-Gimeno C, Beltrán[1]Catalán E. et al. Use of microperimetry to evaluate hydroxychloroquine and chloroquine retinal toxicity. Can J Ophthalmol 2013; 48(5):400-5. doi: 10.1016/j.jcjo.2013.03.018.
- Tzekov R. Ocular toxicity due to chloroquine and hydroxychloroquine: electrophysiological and visual function correlates. Doc Ophthalmol 2005; 110(1):111-20. doi: 10.1007/s10633-005- 7349-6.
- Ulviye Y, Betul T, Nur TH, Selda C. Spectral domain optical coherence tomography for early detection of retinal alterations in patients using hydroxychloroquine. Indian J Ophthalmol 2013; 61(4):168-71. doi: 10.4103/0301-4738.
- Melles RB, Marmor MF. The risk of toxic retinopathy in patients on long-term hydroxy[1]chloroquine therapy. JAMA Ophthalmol 2014; 132(12):1453-60. doi: 10.1001/jamaophthalmol. 2014.3459.
- Michaelides M, Stover NB, Francis PJ, Weleber RG. Retinal toxicity associated with hydroxychloroquine and chloroquine: risk factors, screening, and progression despite cessation of therapy. Arch Ophthalmol 2011; 129(1):30-9. doi:10.1001/archophthalmol.2010. 321.
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