Retinal Toxicity in Patients Treated With Hydroxychloroquine: A Cross-Sectional Study

Abstract Hydroxychloroquine (HCQ) is an antimalarial medication that can also be used to treat autoimmune diseases. However, it can produce irreversible changes to the retina that lead to visual impairment. The aim of this study was to determine the proportion of patients treated with HCQ who develop retinal toxicity and the risk factors for the development of HCQ-induced retinal toxicity among Iranian patients. The is a cross-sectional clinical study of ۵۹ patients who were treated with HCQ during ۲۰۱۴–۲۰۱۵. A questionnaire was used to collect data on the following demographic and clinical factors: age, gender, type of rheumatic disease, history of cataract surgery, daily and cumulative HCQ dose, and duration of HCQ use. Retinal toxicity was diagnosed on the basis of the automated perimetry results of the central ۱۰° of vision and spectral domain optical coherence tomography. The associations between the demographic and clinical factors and retinal toxicity were assessed, and P < ۰.۰۵ was considered statistically significant. Retinal toxicity was detected in ۱۸ (۳۰.۵%) of the patients, and ۵ (۸.۵ %) developed color vision impairments. There was no association between retinal toxicity and sex (P = ۰.۵۱۴), history of cataract surgery (P = ۰.۴۷۹), type of rheumatic disease (P = ۰.۵۳۹), or daily HCQ dose (P = ۰.۰۶۲). However, there was a significant positive association between retinal toxicity and age (P = ۰.۰۰۶), cumulative HCQ dose (P = ۰.۰۰۲), and duration of HCQ use (P < ۰.۰۰۱). In conclusion, the risk factors for retinal toxicity after HCQ treatment were advanced age, use of a higher cumulative HCQ dose, and a longer duration of treatment.Â