Accelerated hydroxychloroquine toxic retinopathy,Documenta Ophthalmologica

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Accelerated hydroxychloroquine toxic retinopathy
Documenta Ophthalmologica ( IF 2.6 ) Pub Date : 2023-10-03 , DOI: 10.1007/s10633-023-09950-x
Ayushi Mohapatra ₁ , Prasad Gupta ₁ , Dhanashree Ratra ₁

Affiliation

Purpose

To report a case series of patients with retinal toxicity due to hydroxychloroquine (HCQ) within a short span of treatment.

Methods

A retrospective review of case records of patients with accelerated HCQ toxicity within 1 year of starting the treatment was done. Systemic co-morbidities, details of HCQ treatment, details of ocular examination, and results of multimodal investigations were noted.

Results

Nine patients (1 male, 8 females) with age ranging from 40 to 73 years (mean 54.2 ± 13.4 years) who showed accelerated HCQ toxicity were included. None had systemic conditions or drug history predisposing to early HCQ toxicity. The treatment duration ranged from 2 to 11 months and the cumulative HCQ dose ranged from 18 to 120 g (mean 45.0 ± 33.0 g). The visual acuity was normal in 8 (88.9%) patients and retinal evaluation was normal in 4 (44.4%). Optical coherence tomography was abnormal in 4 (44.4%). Six (66.6%) cases had reduced sensitivity in the parafoveal point on visual field testing. All 9 cases had multifocal electroretinographic changes diagnostic of HCQ toxicity. The HCQ treatment was stopped in 8 and continued with reduced dose in 1 patient. The mean duration of follow-up was 11.2 ± 9.6 months during which 5 patients showed improved mfERG and 1 patient had a stable mfERG. Visual fields improvement was noted in 2 cases.

Conclusions

Patients on HCQ need to be kept on regular monitoring with more frequent follow-ups to detect signs of early onset toxicity and prevent permanent visual impairment. mfERG is an important diagnostic tool for HCQ toxicity.

中文翻译：

加速羟氯喹中毒性视网膜病变

目的

报告短期治疗期间因羟氯喹 (HCQ) 引起视网膜毒性的一系列病例。

方法

对开始治疗后 1 年内出现加速 HCQ 毒性的患者的病例记录进行了回顾性审查。记录了全身合并症、HCQ 治疗的详细信息、眼部检查的详细信息以及多模式研究的结果。

结果

纳入了 9 名表现出加速 HCQ 毒性的患者（1 名男性，8 名女性），年龄范围为 40 至 73 岁（平均 54.2 ± 13.4 岁）。没有人患有易患早期 HCQ 毒性的全身性疾病或用药史。治疗持续时间为2至11个月，累积HCQ剂量为18至120克（平均45.0±33.0克）。 8 名患者（88.9%）的视力正常，4 名患者（44.4%）的视网膜评估正常。光学相干断层扫描有 4 例（44.4%）异常。六例（66.6%）病例视野测试中中心凹旁点的敏感性降低。所有 9 例患者均出现诊断 HCQ 毒性的多灶视网膜电图变化。 8 名患者停止 HCQ 治疗，1 名患者继续减少剂量。平均随访时间为 11.2 ± 9.6 个月，期间 5 名患者 mfERG 改善，1 名患者 mfERG 稳定。 2 例观察到视野改善。