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Revista Paraguaya de Reumatología

On-line version ISSN 2413-4341


OJEDA, Aldo  and  MIERS GRANADA, Gloria Rossana. Ocular Toxicity of Hydroxychloroquine. Rev. parag. reumatol. [online]. 2019, vol.5, n.2, pp.63-69. ISSN 2413-4341.

Hydroxychloroquine (HCQ) is a drug widely used in the treatment of various rheumatic and dermatological diseases. It has been shown to improve survival in patients with Systemic Lupus Erythematosus (SLE), being one of the 4 drugs approved by the Food and Drug Administration (FDA) for the treatment of this disease. However, HCQ has been associated with irreversible visual loss due to retinal toxicity. Retinal toxicity is more prevalent than previously thought, reaching 7.5% in patients with more than 5 years of treatment with HCQ and up to 20% after 20 years, when more sensitive methods are used for screening. Risk factors for ocular toxicity are daily dose, especially in relation to body weight, duration of HCQ use, cumulative dose, concomitant use of tamoxifen and the presence of previous macular alterations. Once retinopathy is definitely installed, changes are usually irreversible even after treatment with HCQ is discontinued. Consequently, periodic screening is recommended in order to detect changes early before macular alteration. Traditional evaluation with fundus examination or color vision testing are not recommended as screening methods anymore because they don’t recognize early stages of retinopathy. Instead, techniques such as automated visual fields and SD-OTC are recommended and should be performed annually, beginning after 5 years of HCQ use, in the absence of risk factors. The only effective treatment of this complication is definite suspension of HCQ use.

Keywords : Hydroxychloroquine; toxicity; retina.

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