Abstract :
Background: Hydroxychloroquine (HCQ), a derivative of chloroquine, is widely used to treat autoimmune diseases such as rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE). Despite its therapeutic benefits, HCQ can cause ocular toxicity, particularly retinal damage, which can lead to irreversible vision loss.Aim and Objectives: This prospective comparative study aimed to investigate the short- and long-term ocular side effects of HCQ in RA and SLE patients.Materials and Methods: This study included 160 patients who received HCQ doses > 6.5 mg/kg per day or had a cumulative dose exceeding 1000 g. The patients underwent comprehensive ocular examinations, including best-corrected visual acuity, slit-lamp examination, color vision testing, dilated fundus examination, optical coherence tomography, automated perimetry, Amsler grid testing, and fundus autofluorescence imaging.Results: Among 160 patients, 65.6% were aged ?50 years and 69.4% were female. Premaculopathy was the most common ocular manifestation (13.1%), followed by posterior subcapsular cataract (PSC) (9.4%) and bull's eye maculopathy (2.5%). A higher incidence of ocular side effects was noted in patients taking a daily dose of 400 mg, with PSC in 12.6% and premaculopathy in 15.2%. Kidney problems were 8.8%, with a higher prevalence in those using HCQ for ?7 years (11.4%) compared to >7 years (5.6%). Visual acuity assessments revealed that patients receiving HCQ for ?7 years had better outcomes, with 35.2% achieving 6/9 vision in the right eye, whereas those receiving treatment for >7 years showed a decline in visual acuity.Conclusions: The increased recognition of HCQ-induced ocular toxicity is attributable to advances in imaging modalities, heightened clinical awareness, and the implementation of standardized screening guidelines. Asymptomatic patients can exhibit toxicity, which necessitates objective testing methods for early identification.
Keyword :
Hydroxychloroquine, Rheumatoid arthritis, Systemic lupus erythematosus, Retinal toxicity, Ocular side effects, Optical coherence tomography.