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AB1164 Ocular Toxicity of Chloroquine/Hydroxychloroquine: A Case Series of 12 Patients from Tertiary Rheumatology Referral Institute from South India
  1. A.N. Ramakrishnam1,
  2. E. Thachil2,
  3. D. Potikure2,
  4. I.R.V. Prasad2,
  5. H. Shabina2,
  6. N. Gumdal2,
  7. S. Kanchinadham2
  1. 1Rheumatology, Andhra Medical Colege, Visakhapatnam
  2. 2Rheumatology, Nizams Institute of Medical Sciences, Hyderabd, India

Abstract

Background Antimalarials are widely used in the rheumatological practice since six decades and are known for their safety profile. But chloroquine, hydroxychloroquine induced ocular toxicity is rare, may range from reversible retinopathy changes to irreversible bull's eye maculopathy with reported incidence vary from 0.5–3.5%

Objectives To analyzed retrospectively the data of Patients reported with retinopathy secondary to chloroquine/hydroxychloroquine during the routine Ophthalmological screening

Methods Data of Patients reported with retinopathy secondary to chloroquine/hydroxychloroquine during the routine Ophthalmological screening were identified and analyzed retrospectively. The definite toxicity was defined if there was evidence for bull's eye damage. Possible cases defined if there was any evidence of toxicity from the records but details of further testing was not available subsequently

Results Twelve patients were identified. All were female with mean age of 46.5±10. 7 years, eight had rheumatoid arthritis, and four had Systemic lupus erythematosus. All were possible cases of retinopathy, and had early retinopathy changes. Seven of our (58.33%) patients were identified with retinopathy on screening (with spectral domain ocular coherence tomography (SD-OCT)) in 2 asymptomatic patients) within first 5 years. The Mean cumulative dose of Hydroxychloroquine was 370.4±276.4 grams, for a mean duration of 60.17±46.7 months. No-one has received other ocular toxic drugs and only two had predisposing risk factors

Conclusions Ocular toxicity secondary to chloroquine/hydroxychloroquine can occur with lower cumulative dosage and shorter duration of therapy in south Indian population and further prospective studies are needed to confirm. SD-OCT might be a useful technique in asymptomatic patients in detecting early retinopathy changes

References

  1. Pavelka K Jr, et al. Hydroxychloroquine sulphate in the treatment of rheumatoid arthritis: a double blind comparison of two dose regimens. Ann Rheum Dis 1989;48:542-546.

  2. Morand EF, McCloud PI, Littlejohn GO. Continuation of long term treatment with hydroxychloroquine in systemic lupus erythematosus and rheumatoid arthritis. Ann Rheum Dis 1992;51:1318-1321.

  3. Aviña-Zubieta JA, et al, Long term effectiveness of antimalarial drugs in rheumatic diseases. Ann Rheum Dis 1998;57:582-587.

  4. Marmor MF. Efficient and Effective Screening for hydroxychloroquine toxicity. Am J Ophthalmol 2013 March.

  5. Wolfe F, Marmor MF. Rates and predictors of hydroxychloroquine retinal toxicity in patients with rheumatoid arthritis and systemic lupus erythematosus. Arthritis Care Res 2010;62(4):775-784.

Acknowledgements Thanks to Vasan Eye care hospital, Hyderabad; Dr. Agarwal Eye Hospital, Pushpagiri vitreous retina Institute, Anand vitreo retina Institute, Hyderabad for screening our patients; thanks to Vasan Eye care hospital, Vijayawada and Anju Eye care & Alberta Retina Clinic, Kakinada for reviewing the reports.And thanks to all patients for their coperation.

Disclosure of Interest None declared

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