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LONGITUDINAL CHANGES IN EYES WITH HYDROXYCHLOROQUINE RETINAL TOXICITY.

Ali M Allahdina1, Katherine G Chen, Jason A Alvarez

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Hydroxychloroquine (HCQ) retinopathy progression varies after drug cessation. Early-stage retinopathy may stabilize or improve, while advanced stages continue to worsen, highlighting the need for prompt detection and cessation.

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Area of Science:

  • Ophthalmology
  • Retinal Imaging
  • Pharmacology

Background:

  • Hydroxychloroquine (HCQ) is widely used for autoimmune diseases.
  • HCQ retinopathy is a known complication that can lead to vision loss.
  • Monitoring and understanding retinal changes after HCQ cessation are crucial.

Purpose of the Study:

  • To characterize functional and structural changes in hydroxychloroquine (HCQ) retinal toxicity after drug cessation.
  • To correlate these changes with the severity of retinopathy at the time of HCQ cessation.

Main Methods:

  • Multimodal imaging (SD-OCT, fundus autofluorescence) and visual function tests (visual acuity, visual field, mfERG) were used.
  • Patients with HCQ retinopathy were categorized into four severity stages based on OCT findings.
  • Follow-up ranged from 6 to 82 months after HCQ cessation.

Main Results:

  • Visual acuity and visual fields remained stable in early stages (1-2) but declined in advanced stages (3-4).
  • Multifocal electroretinography showed improvement in early stages, but not in advanced stages.
  • Macular thinning and progressive ellipsoid zone loss were observed, particularly in later stages.

Conclusions:

  • Retinal structure and function after HCQ cessation are not universally stable.
  • Severity of HCQ retinopathy at cessation dictates the degree of change during follow-up.
  • Early detection and prompt HCQ cessation are vital to prevent progression and optimize outcomes.