Abstract
Hydroxychloroquine (HCQ) is an antimalarial drug used extensively in treatment of autoimmune diseases such as rheumatoid arthritis. Retinal toxicity is the most important side effects of this drug. Even after the drug is discontinued, retinal degeneration from HCQ can continue to progress. Consequently, multiple ophthalmic screening tests have been developed to detect early retinopathy. The aim of the current study was to evaluate the value of central 2-10 perimetry method in early detection of retinal toxicity. This prospective cross-sectional investigation was carried out on 60 rheumatoid arthritis patients, who had been receiving HCQ for at least 6 months and still were on their medication (HCQ intake) at the time of enrollment. An ophthalmologist examined participants using direct and indirect ophthalmoscopy. Visual field testing with automated perimetry technique (central 2-10 perimetry with red target) was performed on all included subjects twice in 6 months interval: The first one at the time of enrollment and the second one 6 months later. Males and females did not show any significant difference in terms of age, duration of therapy, daily and cumulative HCQ dose, anterior or posterior segment abnormalities, hypertension, body mass index, and best corrected visual acuity. Anterior segment was abnormal in 9 individuals including 3 subjects with macular pigmentary changes, 4 individuals with cataract and 2 cases with dry eyes. Moreover, 12 subjects had retinal pigmented epithelium (RPE) in their posterior segments. After 6 months, depressive changes appeared in 12 subjects. Additionally, HCQ therapy worsened significantly the perimetric results of 5 (55.6%) patients with abnormal anterior segment. A same trend was observed in perimetric results of 6 (50.0%) subjects with abnormal posterior segments (P=0.009). The daily dose of HCQ (P=0.035) as well as the cumulative dose of hydroxychloroquine (P=0.021) displayed statistically significant associations with perimetric results. Central 2-10 perimetry is a useful method for early detection of HCQ retinal toxicity, but more comprehensive studies, with larger sample size, longer-term follow-up and more precise techniques are mandatory to confirm HCQ retinal toxicity.
Highlights
1.1 Introduce the ProblemHydroxychloroquine (HCQ) is an anti-malarial drug that has been used for the treatment of rheumatoid arthritis, systemic lupus erythematosus and some other connective tissue diseases
A same trend was observed in perimetric results of 6 (50.0%) subjects with abnormal posterior segments (P=0.009)
Toxic retinopathy is one of the serious side effects associated with the use of chloroquine and hydroxychloroquine
Summary
1.1 Introduce the ProblemHydroxychloroquine (HCQ) is an anti-malarial drug that has been used for the treatment of rheumatoid arthritis, systemic lupus erythematosus and some other connective tissue diseases. Signs of functional disturbances include pigmentary abnormalities of the PRE, paracentral visual field defects, color vision deficiencies and reading difficulties. If these early signs are overlooked, a severe retinal toxicity with irreversible visual loss may develop. It has been shown that the retinal degeneration caused by HCQ can continue to progress (Marmor, Carr, Easterbrook, Farjo, & Mieler, 2002). For this reason, regular screening for retinal toxicity is recommended to detect early retinopathy and discontinue the therapy. Several different techniques have been proposed so far as screening methods for the early detection of HCQ retinopathy www.ccsenet.org/gjhs
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