J Korean Med Sci.  2017 Mar;32(3):522-527. 10.3346/jkms.2017.32.3.522.

Frequency and Clinical Characteristics of Hydroxychloroquine Retinopathy in Korean Patients with Rheumatologic Diseases

• Eo DR
• Lee MG
• Ham DI
• Kang SW
• Lee J
• Cha HS
• Koh E
• Kim SJ

• KMID: 2366651
• DOI: http://doi.org/10.3346/jkms.2017.32.3.522

Abstract

This study aimed to evaluate the frequency and clinical characteristics of hydroxychloroquine (HCQ) retinopathy in Korean patients with rheumatologic diseases. We retrospectively reviewed medical records of 310 patients taking HCQ. Ophthalmic examinations included spectral-domain optical coherence tomography (SD-OCT), automated visual field test, and fundus autofluorescence. The severity of retinopathy was categorized as early, moderate, or severe, and the location was categorized as parafoveal, pericentral, or mixed pattern. Among 310 patients, 9 patients (2.9%) were diagnosed as HCQ retinopathy. Among the patients with HCQ use ≥ 5 years (n = 174), the frequency was 5.2%. Only 1 (11.1%) of the 9 patients was symptomatic. The mean daily dose per kilogram of real body weight of the 9 patients was 5.6 mg, and only 3 had used 6.5 mg or more. Four of the 9 patients had severe HCQ retinopathy. Six of the 9 patients showed pericentral or mixed pattern of retinal damage. Consequently, the frequency of HCQ retinopathy in Korean patients was not low, especially when administered at a high cumulative dose and for a long duration. Screening of HCQ retinopathy by the recommended guidelines that include SD-OCT seems useful and should be done to detect retinal damage earlier in patients with chronic exposure to HCQ.

Keyword

Hydroxychloroquine; Hydroxychloroquine Retinopathy; Screening

MeSH Terms

Body Weight
Humans
Hydroxychloroquine*
Mass Screening
Medical Records
Retinaldehyde
Retrospective Studies
Tomography, Optical Coherence
Visual Field Tests
Hydroxychloroquine
Retinaldehyde

Figure

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  Fig. 1 Photographs showing pattern of HCQ retinopathy. (A) Parafoveal. (B) Mixed. (C) Pericentral pattern. HCQ = hydroxychloroquine.

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  Fig. 2 Graphs showing distribution of patients with HCQ retinopathy according to the duration of HCQ (A), cumulative dose of HCQ intake (B), and daily dose/real body weight (C). Black dots indicate each value of patients with HCQ retinopathy. HCQ = hydroxychloroquine.

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