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Doo-ri Eo, Mingyu Lee, Sang Jin Kim; Prevalence and clinical characteristics of hydroxychloroquine retinopathy in Korea. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):1794.
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© ARVO (1962-2015); The Authors (2016-present)
Hydroxychloroquine (HCQ) is widely used in the treatment of various rheumatologic diseases such as systemic lupus erythematosus and rheumatoid arthritis. Retinal toxicity from HCQ is a well-known side effect, but the overall incidence of retinal toxicity from HCQ has been reported to be low. However, recent screening methods with objective imaging modalities including spectral domain-optical coherence tomography (SD-OCT) and fundus autofluorescence (FAF) revealed that HCQ retinopathy is more common than previously recognized. In this study, we evaluated the prevalence and clinical characteristics of HCQ retinopathy in Korean patients with rheumatologic diseases.
According to the revised American Academy of Ophthalmology (AAO) recommendations regarding screening for HCQ retinopathy, patients with chronic exposure to HCQ underwent screening examinations including dilated fundus examination, visual field testing in the form of static, automated threshold perimetry (10-2 Humphrey Field Analyzer), FAF, and SD-OCT. HCQ retinopathy was categorized as early, moderate, or severe according to the prior criteria.
Three hundred and ten patients with exposure to HCQ were finally included. The mean age of patients was 44.5 years; a total of 286 patients (92.3%) were female. Mean duration of HCQ use was 72.0 months and mean cumulative exposure of HCQ was 624.8g. Among the overall 310 patients, 10 patients (3.2%) showed clinically evident HCQ retinopathy with characteristic visual field loss or photoreceptor damage in SD-OCT. Among the 172 patients with HCQ use ≥ 5years, the prevalence of HCQ retinopathy was 5.8%. All the 10 patients with HCQ retinopathy were asymptomatic at the time of screening exam. In patients with HCQ retinopathy, mean duration of HCQ use was 110.5 months and mean cumulative exposure of HCQ was 945.6 g. Of the 10 patients, 4 patients showed severe HCQ retinopathy, 3 patients showed moderate retinopathy, and 3 patients showed early retinopathy.
In Korean patients, HCQ retinopathy detected by revised AAO recommendations is more common than previously recognized, especially in cases with long duration of use. This study highlights the importance of screening for HCQ retinopathy by revised screening system with objective imaging modalities.
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