J Rheum Dis.  2015 Jun;22(3):140-145. 10.4078/jrd.2015.22.3.140.

Hydroxychloroquine Retinopathy

• Lee J
• Lee JY

• KMID: 2222879
• DOI: http://doi.org/10.4078/jrd.2015.22.3.140

Abstract

Hydroxychloroquine (HCQ) has been widely used for treatment of various rheumatic and dermatologic diseases. However, under a high cumulative dose, HCQ may cause retinal toxicity. In this review, we summarize the underlying mechanisms, prevalence, risk factors, clinical characteristics, screening tests, treatments, and prognosis of HCQ retinopathy. Because HCQ retinopathy is rarely reversible, screening tests to determine the retinal toxicity prior to its development are important. The American Academy of Ophthalmology screening protocols for early detection were updated in 2013. However, as a different clinical type is found in Asian patients, predominantly the pericentral type of photoreceptor damage, rather than the traditional parafoveal type, we propose a modified screening protocol for detection of HCQ retinopathy in Korean and other Asian patients.

Keyword

Hydroxychloroquine; Retina; Toxicity

MeSH Terms

Asian Continental Ancestry Group
Humans
Hydroxychloroquine*
Mass Screening
Ophthalmology
Prevalence
Prognosis
Retina
Retinaldehyde
Risk Factors
Hydroxychloroquine
Retinaldehyde

Figure

• 

  Figure 1. Comparisons of parafoveal type and pericentral type of hydroxychloroquine retinopathy. (A) Fundus autofluorescence images of normal (left), parafoveal type (middle), and pericentral type (right) hydroxychloroquine retinopathy. Hyperfluorescent area indicating the damage of retinal pigment epithelium was highlighted as dot line. (B) Spectral-domain optical coherence tomography images of normal (left), parafoveal type (middle), and pericentral type (right) hydroxychloroquine retinopathy. (C) 30-2 visual field tests of normal (left), parafoveal type (middle), and pericentral type (right) hydroxychloroquine retinopathy.

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  Figure 2. Parafoveal type hydroxychloroquine retinopathy. (A) Fundus photography of typical bull's eye maculopathy. (B) Fundus autofluorescence image showing parafoveal hypera-utofluorescence. (C) Spectral-domain optical coherence tomography images presenting parafoveal damages of photo-receptors and retinal pigment epithelium (arrows). (D) Central scotoma at 30-2 visual field test and ring scotoma in 10-2 visual field tests.

• 

  Figure 3. Pericentral type hydroxychloroquine retinopathy. (A) Fundus photography of in-visible typical bull's eye mac-ulopathy. (B) Fundus autofluorescence image showing large hyperautofluorescent area involving optic disc at pericentral retina. (C) Pericentral scotoma at 30-2 visual field test, but normal 10-2 visual field test. (D) Spectral-domain optical coherence tomography images presenting pericentral damages of photoreceptors and retinal pigment epithelium (arrows).

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