Retinopathy due to antimalarial drugs in patients with connective tissue diseases: are they so innocent? A single center retrospective study.
BACKGROUND
Antimalarial medications are basal active drugs used for the treatment of various rheumatological conditions. Their common side-effects include eye damage.


OBJECTIVE
The aim of this study is to determine the safety of antimalarial medications used for rheumatological conditions and the incidence of retinopathy.


METHODS
Eighty-five patients with rheumatological conditions, who were followed in our rheumatology clinics between 2005 and 2009 while under chloroquine (CQ) and/or hydroxychloroquine (HQ) treatment were included in the study. Indirect ophthalmoscopic examination with 90 dioptry lens, frontal segment examination and macular visual area test were applied to all patients. Severity of retinopathy was evaluated as mild initial defect in the macula, or severe visual area loss.


RESULTS
Retinopathy findings were detected in 21 out of 85 patients (24.7%). Of these patients, 12 had mild initial defects while nine had severe visual area loss. Of 21 patients, eight were on HQ and 13 were on CQ treatment. Of the patients seen with findings of retinopathy, 17 had comorbid hypertension (HT) and six had diabetes mellitus (DM). Patients receiving CQ are under higher risk compared to those on HQ treatment (P = 0.001). Patient age, disease duration, HT and DM presence had no statistically significant effect on retinopathy development (P = 0.144, P = 0.305, P = 0.258, P = 0.395, respectively).


CONCLUSIONS
The incidence of retinopathy among patients using antimalarial medications as observed in this study was relatively high. Based on these results, it is essential to emphasize the importance of close monitoring in patients receiving antimalarial medications and evaluation of visual findings before treatment initiation.
Kobak
Senol
S
Departments of Rheumatology, Manisa Hospital, Manisa, Turkey. senolkobak@yahoo.com
Deveci
Hulya
H
D000293:Adolescent; D000328:Adult; D000368:Aged; D000962:Antimalarials / Q000009:adverse effects*; D001172:Arthritis, Rheumatoid / Q000150:complications; D016009:Chi-Square Distribution; D002738:Chloroquine / Q000009:adverse effects*; D003240:Connective Tissue Diseases / Q000150:complications*; D005260:Female; D006801:Humans; D006886:Hydroxychloroquine / Q000009:adverse effects*; D008180:Lupus Erythematosus, Systemic / Q000150:complications; D008288:Malaria / Q000150:complications / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D009887:Ophthalmoscopy; D012164:Retinal Diseases / Q000139:chemically induced* / Q000175:diagnosis / Q000503:physiopathology; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D012859:Sjogren's Syndrome / Q000150:complications; D013997:Time Factors; D014421:Turkey; D014785:Vision, Ocular / Q000187:drug effects; D058609:Visual Field Tests; D055815:Young Adult
D000962:Antimalarials; D006886:Hydroxychloroquine; D002738:Chloroquine