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Hydroxychloroquine retinopathy

Nada Abdulaziz, Anjali R Shah, William J McCune
PURPOSE OF REVIEW: Antimalarial drugs including chloroquine, its less toxic quinolone-derivative hydroxychloroquine (HCQ), and quinacrine have become cornerstones in the treatment of autoimmune diseases including systemic lupus, rheumatoid arthritis, sarcoidosis, and Sjogren syndrome; cutaneous disorders, antiphospholipid syndrome, and have recently been employed at higher dioses in oncology. Benefits include anti-inflammatory effects, protection against thrombosis, and improved control of hyperglycemia and hyperlipidemia...
March 6, 2018: Current Opinion in Rheumatology
A Guiot, M Couturier, J G Tebib, L Abouaf, F Coury
INTRODUCTION: Antimalarial drugs are largely used for the treatment of various systemic diseases. They can cause toxic retinopathy, which can lead to blindness. OBSERVATION: We report the case of a 32-year-old male with a systemic lupus erythematosus treated with hydroxychloroquine 400mg per day and then chloroquine 300mg per day during 8 and 9years respectively. Eighteen months after his latest visual examination, the patient experienced bilateral vision loss. Fundus examination revealed a bull's eye maculopathy...
February 26, 2018: La Revue de Médecine Interne
Mustafa Eren, Murat Kucukevcilioglu, Ali Hakan Durukan
PURPOSE: To examine retinal sensitivity in patients on hydroxychloroquine (HCQ) with no evidence of retinopathy. MATERIALS AND METHODS: 70 patients on HCQ and 30 healthy control subjects were included prospectively. All subjects underwent complete ophthalmic examination including best corrected visual acuity, tonometry, color vision testing, biomicroscopy of anterior segment, dilated fundoscopy, 10-2 visual field testing and Spectral domain optical coherence tomography...
March 1, 2018: Cutaneous and Ocular Toxicology
Kumar Saurabh, Rupak Roy, Nicey Roy Thomas, Maitreyi Chowdhury
Hydroxychloroquine (HCQ) is known to cause retinal toxicity. Early detection of the toxicity is necessary to stop the drug in time. Multicolor imaging (MC) is a new noninvasive retinal imaging modality that simultaneously acquires three reflectance images of the retina using three individual lasers producing a composite image, thereby allowing analysis of changes at various levels within the retina. It is a new and promising addition to the retinal imaging armory. MC characteristics of HCQ toxicity are hitherto unreported...
February 2018: Indian Journal of Ophthalmology
Seong Joon Ahn, So Jung Ryu, Han Woong Lim, Byung Ro Lee
PURPOSE: To investigate the choroidal changes that occur in hydroxychloroquine (HCQ) retinopathy using multimodal imaging including fluorescein angiography, indocyanine green angiography, and optical coherence tomography (OCT) angiography and to correlate these changes with retinal findings obtained using OCT and fundus autofluorescence. METHODS: In 20 patients (n = 40 eyes) with systemic lupus erythematosus or rheumatoid arthritis diagnosed to have HCQ retinopathy, imaging modalities including swept-source OCT, fundus autofluorescence, fluorescein angiography, indocyanine green angiography, and OCT angiography were used to evaluate retinal and choroidal changes associated with retinopathy...
January 24, 2018: Retina
Rosanna Dammacco
Systemic lupus erythematosus (SLE) is a multisystem autoimmune disease of undefined etiology and with remarkably heterogeneous clinical features. Virtually any organ system can be affected, including the eye. SLE-related eye involvement can be diagnosed in approximately one-third of the patients and is usually indicative of disease activity. An early diagnosis and the adoption of suitable therapeutic measures are necessary to prevent sight-threatening consequences, especially in patients with juvenile SLE. Periocular lesions, such as eyelid involvement and orbital inflammation, are relatively rare and, in case of orbital masses, may require a biopsy control...
December 14, 2017: Clinical and Experimental Medicine
A Couturier, A Giocanti-Aurégan, B Dupas, J-F Girmens, Y Le Mer, N Massamba, E Barreau, I Audo
INTRODUCTION: Recommendations for screening for chloroquine (CQ) and hydroxychloroquine (HCQ) retinopathy have recently been changed by the American Academy of Ophthalmology, taking into account new published data on toxicity prevalence, risk factors, location of onset in the retina and the efficacy of screening tests. METHODS: Literature review. RESULTS AND DISCUSSION: The risk of developing CQ or HCQ retinopathy depends on the daily dose and duration of treatment...
November 2017: Journal Français D'ophtalmologie
Wadakarn Wuthisiri, Yu-Hung Lai, Jenina Capasso, Martin Blidner, David Salz, Erik Kruger, Alex V Levin
Visual loss in systemic lupus erythematosus (SLE) due to autoimmune retinopathy (AIR) is rare and easily misdiagnosed as hydroxychloroquine retinopathy. We report the rare clinical presentation of severe visual loss in a patient with SLE due to nonparaneoplastic AIR as differentiated from hydroxychloroquine toxicity. A 70-year-old female diagnosed and treated for lupus for 17 years and had been taking hydroxychloroquine for 15 years. Over the past 2 years, she developed progressive peripheral visual loss oculus uterque which rapidly advanced in the latter 6 months...
July 2017: Taiwan Journal of Ophthalmology
Ethan M Stern, Jordan S Johnson, Donald A Mazzulla
BACKGROUND: Hydroxychloroquine (HCQ, Plaquenil) is often prescribed in lieu of other sulfate antimalarials to treat rheumatologic diseases because of its pharmacologic efficacy and few reported side effects. However, a known potential side effect of HCQ is retinal toxicity. CASE REPORT: A 61-year-old black female presented for screening of ophthalmic disease 2 months after initiation of HCQ for the treatment of polyarthralgia with a positive rheumatoid factor. At the time of the examination, she had taken a cumulative total of 19...
2017: Ochsner Journal
Lavanya Mittal, Lingqiao Zhang, Rui Feng, Victoria P Werth
BACKGROUND: Although existing evidence demonstrates the efficacy of antimalarials for rheumatic skin disease, the safety of these medications, and particularly quinacrine, remains debated. OBJECTIVE: We investigated the toxicity risk associated with antimalarials in patients with cutaneous lupus erythematosus and dermatomyositis. METHODS: A total of 532 patients (mean age, 52.29 years; sample composition by sex, 85.15% female vs 14.85% male) were selected from 2 databases on cutaneous lupus erythematosus (69...
January 2018: Journal of the American Academy of Dermatology
Seong Joon Ahn, Jooyoung Joung, Han Woong Lim, Byung Ro Lee
PURPOSE: To investigate the distribution of outer retinal changes in hydroxychloroquine (HCQ) retinopathy and explore optical coherence tomography (OCT) protocols to maximize the sensitivity of HCQ retinopathy detection in Asian patients. DESIGN: Diagnostic validity assessment. METHODS: Setting: Institutional. PATIENT POPULATION: Forty-eight eyes (24 patients) with HCQ retinopathy underwent 6-mm horizontal and vertical line scans and 6 × 6-mm2 volume scans using spectral-domain OCT (SD-OCT), and 9-mm line scans and 6 × 6-mm2 and 12 × 9-mm2 volume scans using swept-source OCT (SS-OCT)...
December 2017: American Journal of Ophthalmology
M P Wiacek, D Bobrowska-Snarska, W Lubiński, M Brzosko, M Modrzejewska
Based on the present literature, in March 2016, new recommendations of the American Academy of Ophthalmology for ophthalmic screening tests in patients treated with chloroquine and hydroxychloroquine were published. These recommendations emphasized the fact that toxicity is related to the dose calculated by real weight. The recommended hydroxychloroquine and chloroquine doses have been limited. It is no longer recommended to calculate the cumulative dose of chloroquine to establish the risk of toxicity. Kidney failure and the use of tamoxifen are proven risk factors of ocular complications in these patients...
August 2017: Nigerian Journal of Clinical Practice
Seong Joon Ahn, So Jung Ryu, Joo Young Joung, Byung Ro Lee
PURPOSE: To investigate choroidal thickness in patients using hydroxychloroquine (HCQ) and compare choroidal thickness between eyes with and without HCQ retinopathy. DESIGN: Retrospective case series. METHODS: Setting: Institutional. PATIENTS: We included 124 patients with systemic lupus erythematosus or rheumatoid arthritis who were treated with HCQ. The patients were divided into an HCQ retinopathy group and a control group, according to the presence or absence of HCQ retinopathy...
November 2017: American Journal of Ophthalmology
Eun Hee Hong, Seong Joon Ahn, Han Woong Lim, Byung Ro Lee
BACKGROUND: Hydroxychloroquine (HCQ) retinopathy can accompany other retinal complications such as cystoid macular edema (CME), which leads to central visual loss. We report a case of CME with HCQ retinopathy that improved with the use of oral acetazolamide, and discussed the possible mechanisms of CME in HCQ retinopathy using multimodal imaging modalities. CASE PRESENTATION: A 62-year-old patient with systemic lupus erythematosus (SLE) and HCQ retinopathy developed bilateral CME with visual decline...
July 12, 2017: BMC Ophthalmology
Emrah Kan, Konuralp Yakar, Mehmet Derya Demirag, Mustafa Gok
PURPOSE: This study evaluated the macular ganglion cell-inner plexiform layer (GC-IPL) thickness using spectral-domain (SD) optical coherence tomography (OCT) in patients with chronic exposure to hydroxychloroquine (HCQ). METHODS: A total of 90 patients (90 eyes) treated with HCQ for at least 5 years and normal controls were included in the study. A fundus examination, automated threshold perimetry, and GC-IPL thickness measurements using the Cirrus high-definition OCT ganglion cell analysis algorithm were performed in all patients treated with HCQ...
July 10, 2017: International Ophthalmology
Preeti Patil Chhablani, Vikas Ambiya, Akshay G Nair, Sailaja Bondalapati, Jay Chhablani
PURPOSE: Imaging technology has advanced by leaps and bounds in the recent past and has resulted in a much greater understanding of ocular diseases. The aim of this review article is to summarize optical coherence tomography (OCT) findings of various systemic conditions. METHOD: A systematic literature search of the Medline/PubMed database was performed. English articles up to April 2015 were included. Terms used for search included: Alzheimer's Disease; Multiple Sclerosis; Parkinson's Disease; Behçet's Disease; Schizophrenia; Migraine; Obstructive Sleep Apnea Syndrome; Neurofibromatosis; Sickle Cell Disease; Renal diseases; Lupus Retinopathy; Valsalva Retinopathy; Whiplash Retinopathy; Shaken-Baby Syndrome; Choroidal metastases; Intracranial Hypertension; Drug toxicity; Deferoxamine; Sildenafil; Tamoxifen; Hydroxychloroquine; Chloroquine; Ethambutol; Lead; Sickle Cell Disease; and Thalassemia along with OCT...
June 22, 2017: Seminars in Ophthalmology
W R Tucker, J Galloway, S Walsh
No abstract text is available yet for this article.
June 2017: British Journal of Dermatology
Archana A Nair, Michael F Marmor
PURPOSE: To study whether the ERG and other clinical findings help to distinguish between advanced hydroxychloroquine (HCQ) retinopathy and pericentral or diffuse retinitis pigmentosa (RP) with similar fundus appearance. METHODS: We conducted a retrospective analysis of patients with advanced HCQ retinopathy (n = 11), pericentral RP (n = 8) and diffuse RP (n = 8). Pericentral RP was defined as having limited fundus damage and relatively normal flicker ERG time-to-peak...
June 2017: Documenta Ophthalmologica. Advances in Ophthalmology
Stefano Sebastiani, Michela Fresina, Mauro Cellini, Emilio C Campos
PURPOSE: To evaluate early changes in multifocal electroretinogram (mfERG) and subclinical aqueous humor flare and cellularity in patients receiving hydroxychloroquine (HCQ) as treatment for rheumatoid arthritis. METHODS: Ten patients receiving treatment with HCQ and no ophthalmic symptoms were enrolled. After complete ocular examination, mfERG and laser flare-cell photometry were performed. Patients were also divided into two subgroups with HCQ cumulative dose (CD) higher or lower than 500 g...
2017: Clinical Ophthalmology
Anthony P Fernandez
Hydroxychloroquine has unique immunomodulatory properties and an attractive adverse effect profile. Over the past 10 years, research has led to significant updates in clinical recommendations concerning the optimal use of hydroxychloroquine and monitoring of patients taking it. We discuss updated recommendations concerning hydroxychloroquine daily dosing, retinopathy screening, serologic monitoring, use in smokers, use in pregnant women, and adverse effect risk and monitoring. This review can hopefully serve as an aid to dermatologists and help ensure they continue using hydroxychloroquine safely and effectively...
June 2017: Journal of the American Academy of Dermatology
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