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Cheng T, Gu X, Yang Z, Wang C, Chen Y, Zhao X. Clinical features of ocular damage in systemic lupus erythematosus and risk factors of hydroxychloroquine related complications. Surv Ophthalmol 2024:S0039-6257(24)00052-3. [PMID: 38782129 DOI: 10.1016/j.survophthal.2024.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 05/16/2024] [Accepted: 05/20/2024] [Indexed: 05/25/2024]
Abstract
Ocular damage in systemic lupus erythematosus (SLE) may cause insidious visual impairment, but its clinical features and the risk of hydroxychloroquine (HCQ)-related complications are still controversial. We performed a meta-analysis to evaluate ocular damage in SLE, the correlation between eye and systemic involvement, and the ocular side effects of treatment. The database PubMed, Embase, and Ovid were used for literature from reception to July, 2023, and the calculation was carried out with R. About 48,693 patients from 66 studies were included. The results indicated that ocular damage in SLE was insidious, appearing in 28% of patients with no complaints. The most common symptoms and manifestations were dry eye (30%) and keratoconjunctivitis sicca (26%). Retinopathy was detected in 10% of patients and was related to antiphospholipid antibodies (25% versus 8%). The proportion of retinopathy also significantly increased in patients with lupus nephropathy or neuropsychiatric systemic lupus erythematosus (risk ratio of 2.29 and 1.95, respectively). HCQ was used in 82% of patients, of which 4% suffered from ocular toxicity. HCQ-related retinopathy was dose-dependent. Dosage below 5mg/kg/d was relatively effective and safe for long-term use, while routine examination was recommended.
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Affiliation(s)
- Tiantian Cheng
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China; Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College
| | - Xingwang Gu
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China; Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College
| | - Zuyi Yang
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China; Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College
| | - Chuting Wang
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China; Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College
| | - Youxin Chen
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China; Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College.
| | - Xinyu Zhao
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China; Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College.
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Tang J, Liu H, Mo S, Zhu Z, Huang H, Liu X. Cone Density Distribution and Related Factors in Patients Receiving Hydroxychloroquine Treatment. Invest Ophthalmol Vis Sci 2023; 64:29. [PMID: 37713205 PMCID: PMC10506682 DOI: 10.1167/iovs.64.12.29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/16/2023] Open
Abstract
Purpose Hydroxychloroquine is an effective treatment for rheumatic diseases; however, retinal damage is a possible side effect. We aimed to identify the retinal area and related risk factors associated with cone density reduction caused by hydroxychloroquine. Methods We recorded the retinal images of patients with rheumatic diseases taking hydroxychloroquine (n = 44) and compared them with images of healthy controls (n = 107). Cone density was obtained in vertical and horizontal axes. Regions of decreased cone density and associations between age, rheumatic disease type, dosage for ideal body weight, and cone density were evaluated. Results Cone densities were significantly lower in hydroxychloroquine-treated patients than in sex- and age-matched controls in the vertical axis (P < 0.001), with no significant difference in the horizontal axis (P = 0.120); in healthy elderly than in healthy young people in the horizontal axis (P < 0.001), with no significant difference in the vertical axis (P = 0.100); in hydroxychloroquine-treated elderly than in hydroxychloroquine-treated young patients in both axes (both P < 0.05); among patients with different rheumatic disease types, with no significant difference in the vertical axis (P = 0.294). The daily dose was negatively correlated with cone density in the vertical axis and inferior quadrant. Conclusions Hydroxychloroquine reduces retinal cone cell density in the vertical axis. Cone density loss in the horizontal axis increases with age; further, hydroxychloroquine dosage is negatively correlated with cone density in the vertical axis and inferior quadrant. Early screening of hydroxychloroquine-related retinal injury should consider changes in cone density in the vertical axis.
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Affiliation(s)
- Jun Tang
- Department of Rheumatology and Immunology, Hainan Hospital of Chinese PLA General Hospital, Hainan, China
- Institute of Life Science and Laboratory of Tissue and Cell Biology, Lab Teaching & Management Center, Chongqing Medical University, Chongqing, China
| | - Hua Liu
- Department of Ophthalmology, Hainan Hospital of Chinese PLA General Hospital, Hainan, China
| | - Shiyan Mo
- Department of Rheumatology and Immunology, Hainan Hospital of Chinese PLA General Hospital, Hainan, China
| | - Zhihong Zhu
- Department of Ophthalmology, Hainan Hospital of Chinese PLA General Hospital, Hainan, China
| | - Houbin Huang
- Department of Ophthalmology, Hainan Hospital of Chinese PLA General Hospital, Hainan, China
| | - Xiaofei Liu
- Department of Rheumatology and Immunology, Hainan Hospital of Chinese PLA General Hospital, Hainan, China
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Abstract
ABSTRACT Drug therapy for patients with systemic lupus erythematosus (SLE) aims to decrease symptom severity. Pharmacologic interventions are divided into four categories: antimalarials, glucocorticoids (GCs), immunosuppressants (ISs), and biological agents. Hydroxychloroquine, the most commonly used antimalarial treatment for this disease, is a mainstay in treating all patients with SLE. The multitude of adverse reactions of GCs has led clinicians to minimize their dosages or discontinue them whenever possible. To speed up the discontinuation or minimization of GCs, ISs are used for their steroid-sparing properties. Furthermore, certain ISs such as cyclophosphamide are recommended as maintenance agents to prevent flares and reduce the reoccurrence and severity of the disease state. Biological agents are recommended when other treatment options have failed due to intolerance or inefficacy. This article presents pharmacologic approaches for managing SLE in patients based on clinical practice guidelines and data from randomized controlled trials.
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POLAT OA, OKÇU M, YILMAZ M. HYDROXYCHLOROQUINE TREATMENT ALTERS RETINAL LAYERS AND CHOROID WITHOUT APPARENT TOXICITY IN OPTICAL COHERENCE TOMOGRAPHY. Photodiagnosis Photodyn Ther 2022; 38:102806. [DOI: 10.1016/j.pdpdt.2022.102806] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 02/26/2022] [Accepted: 03/10/2022] [Indexed: 10/18/2022]
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Kurna SA, Kanar HS, Garlı M, Çakır N. Evaluation of The Role of Spectral-Domain Optical Coherence Tomography in The Early Detection of Macular and Ganglion Cell Complex Thickness Changes in Patients with Rheumatologic Diseases Taking Hydroxychloroquine. Photodiagnosis Photodyn Ther 2022; 38:102741. [DOI: 10.1016/j.pdpdt.2022.102741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Revised: 01/24/2022] [Accepted: 01/27/2022] [Indexed: 10/19/2022]
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Sallam MA, Beltagi AS, Abdellatif MA, Awadalla MA. Visual Impact of Early Hydroxychloroquine-Related Retinal Structural Changes in Patients with Systemic Lupus Erythematosus. Ophthalmologica 2021; 244:301-308. [PMID: 34015786 DOI: 10.1159/000517090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 05/05/2021] [Indexed: 11/19/2022]
Abstract
PURPOSE The aim of the study was to assess the early retinal structural changes due to hydroxychloroquine (HCQ) use and its impact on visual acuity (VA) of patients with systemic lupus erythematosus (SLE). PATIENTS AND METHODS The study was conducted as a case-control study that included 60 eyes of 30 SLE patients treated with HCQ compared with 50 eyes of 25 healthy individuals. Patients were kept on 200 or 400 mg as daily maintenance dose. SLE patients were subgrouped into patients with normal VA and patients with decreased VA. All participants were assessed by the optical coherence tomography (OCT), and early structural abnormalities were recorded. The main outcomes and measures were best-corrected VA, drug exposure time, central macular thickness (CMT), inner segment-outer segment (IS-OS) junction disruption, ganglion cell complex † (GCC†, ganglion cell layer + inner plexiform layer), ganglion cell complex †† (GCC††, nerve fiber layer + GCC†), and peripapillary retinal nerve fiber layer. The characteristics of HCQ retinal toxicity were correlated to VA. RESULTS All OCT parameters were found to be significantly lower (p < 0.001) in HCQ patients with decreased VA than in controls. Patients receiving a daily dose of 400 mg had lower (p < 0.05) parameters than those receiving 200 mg. Patients with IS-OS disruption had lower CMT, GCC †, and GCC †† than those without (p < 0.05). VA was significantly correlated (p < 0.05) with CMT and drug exposure time. CONCLUSIONS The HCQ use caused OCT changes that precede clinically visible retinopathy and might be associated with slight VA reduction. Screening with OCT of patients receiving HCQ is essential to detect early vision loss.
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Affiliation(s)
- Moataz A Sallam
- Ophthalmology Department, Suez Canal University Hospitals, Ismailia, Egypt
| | - Arwa S Beltagi
- Rheumatology Department, Suez Canal University Hospitals, Ismailia, Egypt
| | - Mai A Abdellatif
- Rheumatology Department, Suez Canal University Hospitals, Ismailia, Egypt
| | - Magdy A Awadalla
- Rheumatology Department, Suez Canal University Hospitals, Ismailia, Egypt
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Akhlaghi M, Kianersi F, Radmehr H, Dehghani A, Naderi Beni A, Noorshargh P. Evaluation of optical coherence tomography angiography parameters in patients treated with Hydroxychloroquine. BMC Ophthalmol 2021; 21:209. [PMID: 33975575 PMCID: PMC8112017 DOI: 10.1186/s12886-021-01977-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 05/04/2021] [Indexed: 12/02/2022] Open
Abstract
Background One of the major side effects of Hydroxychloroquine (HCQ) is retinopathy. The aim of this study was to evaluate the Optical coherence tomography angiography (OCTA) parameters in a group of patients who have Hydroxychloroquine-induced retinopathy based on Multifocal electroretinography (mfERG) with a group who do not have retinopathy. Method This is a Cross-Sectional Study. In this study, patients with Rheumatoid arthritis (RA) or Systemic lupus erythematosus (SLE) who had been taking Hydroxychloroquine for at least 7 years were included. MfERG and OCTA imaging were performed for all patients. Patients were divided into Normal mfERG and Abnormal mfERG groups based on mfERG results. OCTA parameters were studied in these two groups. Result Sixty-one patients (61 eyes) were included. Forty-one patients had SLE and 20 patients had RA. Forty patients (66.7%) had Abnormal mfERG. The mean vascular density (VD) in Superficial capillary plexus (SCP) layer was not significantly different between Normal mfERG and Abnormal mfERG groups (P-Value> 0.05). Mean VD in SCP layer was not significantly different between Normal mfERG and Abnormal mfERG groups (P-Value> 0.05). In RA subgroup, mean VD in SCP layer in PeriFovea region in Abnormal mfERG group was significantly lower than normal group (P-Value < 0.05). Mean VD in deep capillary plexus (DCP) layer in Whole Image, Superior Hemi, Inferior Hemi, PeriFovea area in Abnormal mfERG group was significantly lower than normal group (P-Value < 0.05). This discrepancy was also observed in the RA subgroup but not in the SLE subgroup. The mean of none of the parameters of foveal avascular zone (FAZ) (mm2), Flow Area of Outer Retina (mm2) and Flow Area of Choriocapillaris (mm2) were not statistically significant between the groups Abnormal mfERG and Normal mfERG. (p-value> 0.05). Conclusion VD in the DCP layer decreased in abnormal mfERG patients compared to patients with normal mfERG. But it seems that VD in SCP layer, FAZ Area and Flow Area are similar in both groups. OCTA may be used as a non-invasive tool in the diagnosis of early stages of HCQ-induced retinopathy, especially in RA patients, but further studies are needed.
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Affiliation(s)
- Mohammadreza Akhlaghi
- Isfahan Eye Research Center, Department of Ophthalmology, Isfahan University of Medical Science, Isfahan, Iran
| | - Farzan Kianersi
- Isfahan Eye Research Center, Department of Ophthalmology, Isfahan University of Medical Science, Isfahan, Iran
| | - Hamed Radmehr
- Isfahan Eye Research Center, Department of Ophthalmology, Isfahan University of Medical Science, Isfahan, Iran.
| | - Alireza Dehghani
- Isfahan Eye Research Center, Department of Ophthalmology, Isfahan University of Medical Science, Isfahan, Iran
| | - Afsaneh Naderi Beni
- Isfahan Eye Research Center, Department of Ophthalmology, Isfahan University of Medical Science, Isfahan, Iran
| | - Pegah Noorshargh
- Isfahan Eye Research Center, Department of Ophthalmology, Isfahan University of Medical Science, Isfahan, Iran
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Fouad SA, Esmat Mahmoud Ali SM, Rezk Alnaggar ARL, Mahfouz S, Essam M, El-Gendy H. Structural Retinal Assessment Using Optical Coherence Tomography and Fundus Fluorescein Angiography in Systemic Lupus Erythematosus Patients. J Clin Rheumatol 2021; 27:34-39. [PMID: 31688343 DOI: 10.1097/rhu.0000000000001162] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Ocular manifestations in systemic lupus erythematosus (SLE) can be the presenting symptom of the disease or a sight-threatening complication. OBJECTIVES To detect different structural retinal changes in patients with SLE who had no ophthalmological symptoms and investigate the relationship between different retinal changes and the disease activity assessed by the Systemic Lupus Erythromatosus Disease Activity Index score. STUDY DESIGN A descriptive pilot study from January 2016 to January 2017. METHODS Fifty-two eyes of 26 patients diagnosed to have SLE were examined using visual acuity assessment, fundus examination, optical coherence tomography (OCT), and fundus fluorescein angiography (FFA). RESULTS Fundus fluorescein angiography showed different changes in the form of venular occlusion and optic nerve leakage. There were also degenerative changes in the form of alternating hyperfluorescent and hypofluorescent areas outside the arcades as well as peripapillary areas and capillary dropout. Optical coherence tomography detected signs of degenerative thinning, incomplete posterior vitreous detachment, and epiretinal membrane. A significant correlation was found between SLE activity and the changes detected by FFA (p = 0.017). However, there was no significant correlation between disease activity and changes detected by OCT. Optical coherence tomography changes were significantly correlated with the duration of hydroxychloroquine use of more than 5 years (p = 0.032). There was no correlation between FFA or OCT changes and proteinuria or antiphospholipid antibodies. CONCLUSIONS Fundus fluorescein angiography is more sensitive in detecting early subclinical retinal changes in patients with SLE, which correlates with disease activity, whereas OCT is more sensitive in detecting changes resulting from hydroxychloroquine use.
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Affiliation(s)
- Shawky A Fouad
- From the Department of Internal Medicine, Division of Rheumatology and Clinical Immunology, Kasr Al Einy Hospital, Cairo University
| | | | | | - Safaa Mahfouz
- From the Department of Internal Medicine, Division of Rheumatology and Clinical Immunology, Kasr Al Einy Hospital, Cairo University
| | - Mervat Essam
- From the Department of Internal Medicine, Division of Rheumatology and Clinical Immunology, Kasr Al Einy Hospital, Cairo University
| | - Hala El-Gendy
- From the Department of Internal Medicine, Division of Rheumatology and Clinical Immunology, Kasr Al Einy Hospital, Cairo University
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Yesilirmak N, Telek HH, Sungur G, Ozdemir Y, Yesil NK, Ornek F. Response to risk of hydroxychloroquine retinopathy is not related to systemic lupus erythematosus or rheumatoid arthritis. Doc Ophthalmol 2018; 136:95-96. [PMID: 29383473 DOI: 10.1007/s10633-018-9624-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 01/10/2018] [Indexed: 11/24/2022]
Affiliation(s)
- Nilufer Yesilirmak
- Department of Ophthalmology, Ankara Training and Research Hospital, Sukriye, Ulucanlar St. No: 89, Altindag, 06340, Ankara, Turkey.
| | - Hande Husniye Telek
- Department of Ophthalmology, Ankara Training and Research Hospital, Sukriye, Ulucanlar St. No: 89, Altindag, 06340, Ankara, Turkey
| | - Gulten Sungur
- Department of Ophthalmology, Ankara Training and Research Hospital, Sukriye, Ulucanlar St. No: 89, Altindag, 06340, Ankara, Turkey
| | - Yaprak Ozdemir
- Department of Statistics, Gazi University Hospital, Ankara, Turkey
| | - Nesibe Karahan Yesil
- Department of Rheumatology, Ankara Training and Research Hospital, Ankara, Turkey
| | - Firdevs Ornek
- Department of Ophthalmology, Ankara Training and Research Hospital, Sukriye, Ulucanlar St. No: 89, Altindag, 06340, Ankara, Turkey
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Marmor MF. Retinopathy from hydroxychloroquine is not related to lupus or rheumatoid arthritis. Doc Ophthalmol 2018; 136:93-94. [PMID: 29383474 DOI: 10.1007/s10633-018-9623-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 01/08/2018] [Indexed: 11/27/2022]
Affiliation(s)
- Michael F Marmor
- Byers Eye Institute, Stanford University School of Medicine, Palo Alto, CA, USA.
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