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Hydroxychloroquine retinal toxicity- Can we do better with SD-OCT?

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Review Article

Author Details : Logandran Vijaya Kumar*, Kursiah Mohd Razali, Wan Hazabbah Wan Hitam

Volume : 7, Issue : 3, Year : 2021

Article Page : 457-465

https://doi.org/10.18231/j.ijceo.2021.092

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Abstract

Introduction: Hydroxychloroquine used in the management of connective tissue diseases also used to treat a wide spectrum of diseases. This disease-modifying anti-rheumatic drug can cause irreversible retinal damage and there are preferred practice guidelines for early screening to aid ophthalmologists and all those involved in the management of these patients. Spectral-Domain Optical Coherence Tomography (SD-OCT) currently an important tool in early detection of possible toxicity. Even with the current guideline-recommended 5mg/kg/day dosage, a baseline SD-OCT of the macula should be taken and repeated at 5 years. Many cross-sectional studies using SD-OCT have shown earlier retina damages, but none had monitored continuously from the beginning of Hydroxychloroquine usage. 
Purpose: To evaluate sequential changes of the retina thickness in patients newly treated with hydroxychloroquine.
Materials and Methods: We compared the mean central macular and Retinal Nerve Fiber Layer (RNFL) thickness pre, 3 months and 6 months post hydroxychloroquine using SD-OCT in order to find an association between them over the three time-points.33 previously healthy patients who were newly confirmed clinically and serologically with connective tissue disease planned for hydroxychloroquine who fulfilled the inclusion and exclusion criteria were recruited over 2 years. In consideration of selection criteria and drop-out rate, finally, 26 patients were included in the study.
Results: 26 eyes of 26 patients (20 females and 6 males) were included in the study. The mean age was 33.92. The macula was significantly thinner (P<0 p =0.004, r=0.55). p =0.004, r =0.302) p =0.001, r =0.784)> Conclusion: There is a need for an earlier repetition of SD-OCT imaging before 5 years to detect potential toxicity. Involvement of RNFL requires further investigation and monitoring.
 

Keywords: Hydroxychloroquine, Plaquenil, RNFL Thinning, Macula thinning.

How to cite : Kumar L V, Razali K M, Hitam W H W, Hydroxychloroquine retinal toxicity- Can we do better with SD-OCT?. Indian J Clin Exp Ophthalmol 2021;7(3):457-465

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