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Detection of Hydroxychloroquine Retinal Toxicity by Automated Perimetry in 60
Rheumatoid Arthritis Patients with Normal Fundoscopic Findings
#MMPMID26493438
Motarjemizadeh Q
; Aidenloo NS
; Abbaszadeh M
Glob J Health Sci
2015[Jun]; 8
(3
): 59-64
PMID26493438
show ga
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.
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