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      Is optical coherence tomography angiography a useful tool in the screening of hydroxychloroquine retinopathy?

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          Abstract

          Purpose

          To detect the early changes in retinal vasculature via optical coherence tomography angiography (OCTA) by comparing the quantitative OCTA parameters in the group of patients who were using hydroxychloroquine (HCQ) or not.

          Methods

          This was a cross-sectional, comparative, and observational study. The patients who were newly or previously prescribed HCQ for an autoimmune disease were included. OCTA imaging was performed via OCT RT XR Avanti with AngioVue software (Optivue Inc, Freemont, CA). The study group had two groups: a control group (patients newly diagnosed and who were not taking any medication) and a treatment group (patients who were receiving HCQ treatment). The main outcome measure was OCTA parameters.

          Results

          A total of 102 eyes of 102 patients were included. There were 70 patients in the treatment group and 32 patients in the control group. All of the vascular density values were similar between the control and treatment groups ( p > 0.05 for all). However, the superficial whole thickness, superficial parafoveal thickness, superficial perifoveal thickness, deep whole thickness, deep parafoveal thickness, and deep perifoveal thickness were thinner in the treatment group than the control group ( p < 0.05 for all).

          Conclusion

          Vascular density parameters did not differ between the control and treatment groups. However, the retinal thickness values were lower in the treatment group.

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          Most cited references25

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          The risk of toxic retinopathy in patients on long-term hydroxychloroquine therapy.

          Hydroxychloroquine sulfate is widely used for the long-term treatment of autoimmune conditions but can cause irreversible toxic retinopathy. Prior estimations of risk were low but were based largely on short-term users or severe retinal toxicity (bull's eye maculopathy). The risk may be much higher because retinopathy can be detected earlier when using more sensitive screening techniques.
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            Revised recommendations on screening for chloroquine and hydroxychloroquine retinopathy.

            The American Academy of Ophthalmology recommendations for screening of chloroquine (CQ) and hydroxychloroquine (HCQ) retinopathy were published in 2002, but improved screening tools and new knowledge about the prevalence of toxicity have appeared in the ensuing years. No treatment exists as yet for this disorder, so it is imperative that patients and their physicians be aware of the best practices for minimizing toxic damage. New data have shown that the risk of toxicity increases sharply toward 1% after 5 to 7 years of use, or a cumulative dose of 1000 g, of HCQ. The risk increases further with continued use of the drug. The prior recommendation emphasized dosing by weight. However, most patients are routinely given 400 mg of HCQ daily (or 250 mg CQ). This dose is now considered acceptable, except for individuals of short stature, for whom the dose should be determined on the basis of ideal body weight to avoid overdosage. A baseline examination is advised for patients starting these drugs to serve as a reference point and to rule out maculopathy, which might be a contraindication to their use. Annual screening should begin after 5 years (or sooner if there are unusual risk factors). Newer objective tests, such as multifocal electroretinogram (mfERG), spectral domain optical coherence tomography (SD-OCT), and fundus autofluorescence (FAF), can be more sensitive than visual fields. It is now recommended that along with 10-2 automated fields, at least one of these procedures be used for routine screening where available. When fields are performed independently, even the most subtle 10-2 field changes should be taken seriously and are an indication for evaluation by objective testing. Because mfERG testing is an objective test that evaluates function, it may be used in place of visual fields. Amsler grid testing is no longer recommended. Fundus examinations are advised for documentation, but visible bull's-eye maculopathy is a late change, and the goal of screening is to recognize toxicity at an earlier stage. Patients should be aware of the risk of toxicity and the rationale for screening (to detect early changes and minimize visual loss, not necessarily to prevent it). The drugs should be stopped if possible when toxicity is recognized or strongly suspected, but this is a decision to be made in conjunction with patients and their medical physicians. Copyright © 2011 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.
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              Hydroxychloroquine retinopathy

              Hydroxychloroquine retinopathy

                Author and article information

                Contributors
                h.k.t.1984@hotmail.com
                abdozkaya@gmail.com
                ulviyeyigit@hotmail.com
                Journal
                Int Ophthalmol
                Int Ophthalmol
                International Ophthalmology
                Springer Netherlands (Dordrecht )
                0165-5701
                1573-2630
                27 August 2020
                : 1-7
                Affiliations
                [1 ]GRID grid.414850.c, ISNI 0000 0004 0642 8921, Department of Ophthalmology, , University of Health Sciences Bakirkoy Training and Research Hospital, ; Istanbul, Turkey
                [2 ]GRID grid.490320.c, Department of Ophthalmology, , Memorial Sisli Hospital, ; Okmeydani, Sisli, 34000 Istanbul, Turkey
                [3 ]GRID grid.449300.a, ISNI 0000 0004 0403 6369, Department of Ophthalmology, , Istanbul Aydin University, ; Istanbul, Turkey
                Author information
                http://orcid.org/0000-0002-1940-8669
                Article
                1549
                10.1007/s10792-020-01549-4
                7451225
                32856197
                54460d70-d54a-427a-97dc-27b37da1c996
                © Springer Nature B.V. 2020

                This article is made available via the PMC Open Access Subset for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic.

                History
                : 27 April 2020
                : 16 August 2020
                Categories
                Original Paper

                Ophthalmology & Optometry
                angiography,hydroxychloroquine,optical coherence tomography,retinopathy

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