title: Retinal Toxicity in Patients Treated With Hydroxychloroquine: A Cross-Sectional Study.
abstract: Hydroxychloroquine (HCQ) is an antimalarial medication that can also be used to treat autoimmune diseases. However, it can produce irreversible changes to the retina that lead to visual impairment. The aim of this study was to determine the proportion of patients treated with HCQ who develop retinal toxicity and the risk factors for the development of HCQ-induced retinal toxicity among Iranian patients. The is a cross-sectional clinical study of 59 patients who were treated with HCQ during 2014-2015. A questionnaire was used to collect data on the following demographic and clinical factors: age, gender, type of rheumatic disease, history of cataract surgery, daily and cumulative HCQ dose, and duration of HCQ use. Retinal toxicity was diagnosed on the basis of the automated perimetry results of the central 10° of vision and spectral domain optical coherence tomography. The associations between the demographic and clinical factors and retinal toxicity were assessed, and P < 0.05 was considered statistically significant. Retinal toxicity was detected in 18 (30.5%) of the patients, and 5 (8.5 %) developed color vision impairments. There was no association between retinal toxicity and sex (P = 0.514), history of cataract surgery (P = 0.479), type of rheumatic disease (P = 0.539), or daily HCQ dose (P = 0.062). However, there was a significant positive association between retinal toxicity and age (P = 0.006), cumulative HCQ dose (P = 0.002), and duration of HCQ use (P < 0.001). In conclusion, the risk factors for retinal toxicity after HCQ treatment were advanced age, use of a higher cumulative HCQ dose, and a longer duration of treatment.
authors.affiliation: 1 Department of Ophthalmology, Semnan University of Medical Sciences, Semnan, Iran ; 2 Ophthalmic Research Center, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
authors.forename: Goldis
authors.initials: G
authors.lastname: Espandar
authors.affiliation: 3 Department of Internal Medicine, School of Medicine, Semnan University of Medical Sciences, Semnan, Iran.
authors.forename: Jamileh
authors.initials: J
authors.lastname: Moghimi
authors.affiliation: 4 Research Center of Health Social Determinants, Semnan University of Medical Sciences, Semnan, Iran.
authors.forename: Raheb
authors.initials: R
authors.lastname: Ghorbani
authors.affiliation: 5 Isfahan Eye Research Center, Department of Ophthalmology, Isfahan University of Medical Sciences, Isfahan, Iran.
authors.forename: Mohsen
authors.initials: M
authors.lastname: Pourazizi
authors.affiliation: 6 Students' Research Committee, Semnan University of Medical Sciences, Semnan, Iran.
authors.forename: Mohammad-Ali
authors.initials: MA
authors.lastname: Seiri
authors.affiliation: 6 Students' Research Committee, Semnan University of Medical Sciences, Semnan, Iran.
authors.forename: Shervin
authors.initials: S
authors.lastname: Khosravi
keywords: Autoimmune disease; Automated Perimetry; Hydroxychloroquine; Retinal Toxicity