Detaillierte Beitrags-Information
| Beitragstitel | Keeping an eye on hydroxychloroquine retinopathy |
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| Autor:innen | |
| Präsentationsform | ePoster |
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| Abstract-Text |
Purpose: Hydroxychloroquine (HCQ) is an immunomodulatory agent, initially used to treat malaria, but nowadays mainly used for treating rheumatoid arthritis and lupus. A safe dose of HCQ is either a daily dose ≤5Mg/kg or a total dose < 1000g. Due to the risk of developing an irreversible macular toxicity, regular examination by ophthalmologists is needed. Methods: We present two exemplary cases of HCQ retinal toxicity referred to our unit, demonstrating either a successful early detection at an asymptomatic stage or a late detection of a severely symptomatic patient. Examination included full ophthalmic examination, visual fields, retinal autofluorescence, macular OCT and multifocal Electroretinogram (ERG). We also reviewed the international guidelines regarding the screening methods of patients treated with HCQ. Results: An asymptomatic 66-year-old female was treated with HCQ for the last 17 years (daily dose of 7 mg/kg, total dose 2540g). Examination revealed signs of an early stage maculopathy and HCQ was halted. Vision remained unchanged. A 36-year-old female was treated with HCQ for the last 4 years (daily dose 9.5 mg/kg, total dose 730g) when she complained of reading difficulties. Examination revealed a severe annular scotoma. Therapy was halted, but visual loss was permanent. Conclusion: The incidence of HCQ-induced macular toxicity is related to daily dose and treatment duration, but is difficult to predict. It is estimated to be under 1% up to 5 years, under 2% up to 10 years, and reaches almost 20% after 20 years of use. Despite safe doses of HCQ, some patients will develop a maculopathy. There is no test carrying 100% sensitivity to detect HCQ maculopathy. Therefore, adding to a yearly ophthalmic examination, a battery of tests has been recommended including macular SD-OCT, fundus autofluorescence and central 10° visual fields. Multifocal ERG is recommended after a few years of therapy. HCQ maculopathy can be devastating and is permanent. Careful and regular follow-up examination by the ophthalmologists is mandatory. |