Hydroxychloroquine-induced retinal toxicity in an asymptomatic patient

Hydroxychloroquine-induced retinal toxicity in an asymptomatic patient Rheumatology 2018;0:1 Clinical vignette doi:10.1093/rheumatology/key085 Hydroxychloroquine-induced retinal toxicity in an FIG.1 Investigation findings from this patient demon- asymptomatic patient strating classical features of HCQ-induced retinal toxicity A 68-year-old female treated with HCQ for SS for 15 years was referred for ophthalmic assessment after a high cu- mulative dose was identified (>1500 g on varying doses over time, 200400 mg daily). She had no visual symp- toms but had been identified as being at risk of retinal toxicity due to the length of time on treatment and the significant cumulative dose received. On review, visual acuity was the following: right eye 6/7.5, left eye 6/12. Further investigation demonstrated classical findings of HCQ toxicity [1](Fig. 1). HCQ-induced retinal toxicity is more common than previ- ously thought [2]. The new British Society for Rheumatology/ British Health Professionals in Rheumatology guidelines recommend formal ophthalmic investigation at baseline and at annual intervals in patients receiving treatment beyond 5 years. This should take the form of retinal imaging techniques to include spectrum domain OCT as traditional methods including Amsler charts are not sufficient [2]. This will have implications for service provision. Updated guid- ance from the Royal College of Ophthalmologists is currently in consultation phase. (A) Bulls eye maculopathy on fundal photography; Funding: No specific funding was received from any (B) autofluorescence showing paracentral uptake; bodies in the public, commercial or not-for-profit sectors (C) spectrum OCT demonstrating loss of the paracentral to carry out the work described in this manuscript. retinal layers (flying saucer sign). Disclosure statement: The authors have declared no conflicts of interest. 1 2 2 Andrew Allard , Rachel Healy , Elizabeth Bristow References and Sarah Hickey 1 Marmor M. Comparsion of screening procedures in 1 2 Department of Rheumatology and Department of hydroxychloroquine retinopathy. Arch Ophthalmol Ophthalmology, Gloucestershire Royal Hospitals NHS 2012;130:4619. Foudnation Trust, Gloucester, UK 2 Marmour M, Kellner U, Lai T et al. American Academy of Ophthalmology Statement; Recommendations on Correspondence to: Andrew Allard, Royal National Hospital Screening for Chloroquine and Hydroxychloroquine for Rheumatic Diseases, Upper Borough Walls, Bath Retinopathy (2016 Revision). Ophthalmology BA1 1RL, UK. E-mail: andrew.allard@nhs.net 2016;123:138694. ! The Author(s) 2018. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For permissions, please email: journals.permissions@oup.com Downloaded from https://academic.oup.com/rheumatology/advance-article-abstract/doi/10.1093/rheumatology/key085/4958704 by Ed 'DeepDyve' Gillespie user on 08 June 2018 http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Rheumatology Oxford University Press

Hydroxychloroquine-induced retinal toxicity in an asymptomatic patient

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Oxford University Press
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© The Author(s) 2018. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For permissions, please email: journals.permissions@oup.com
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1462-0324
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1462-0332
D.O.I.
10.1093/rheumatology/key085
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Abstract

Rheumatology 2018;0:1 Clinical vignette doi:10.1093/rheumatology/key085 Hydroxychloroquine-induced retinal toxicity in an FIG.1 Investigation findings from this patient demon- asymptomatic patient strating classical features of HCQ-induced retinal toxicity A 68-year-old female treated with HCQ for SS for 15 years was referred for ophthalmic assessment after a high cu- mulative dose was identified (>1500 g on varying doses over time, 200400 mg daily). She had no visual symp- toms but had been identified as being at risk of retinal toxicity due to the length of time on treatment and the significant cumulative dose received. On review, visual acuity was the following: right eye 6/7.5, left eye 6/12. Further investigation demonstrated classical findings of HCQ toxicity [1](Fig. 1). HCQ-induced retinal toxicity is more common than previ- ously thought [2]. The new British Society for Rheumatology/ British Health Professionals in Rheumatology guidelines recommend formal ophthalmic investigation at baseline and at annual intervals in patients receiving treatment beyond 5 years. This should take the form of retinal imaging techniques to include spectrum domain OCT as traditional methods including Amsler charts are not sufficient [2]. This will have implications for service provision. Updated guid- ance from the Royal College of Ophthalmologists is currently in consultation phase. (A) Bulls eye maculopathy on fundal photography; Funding: No specific funding was received from any (B) autofluorescence showing paracentral uptake; bodies in the public, commercial or not-for-profit sectors (C) spectrum OCT demonstrating loss of the paracentral to carry out the work described in this manuscript. retinal layers (flying saucer sign). Disclosure statement: The authors have declared no conflicts of interest. 1 2 2 Andrew Allard , Rachel Healy , Elizabeth Bristow References and Sarah Hickey 1 Marmor M. Comparsion of screening procedures in 1 2 Department of Rheumatology and Department of hydroxychloroquine retinopathy. Arch Ophthalmol Ophthalmology, Gloucestershire Royal Hospitals NHS 2012;130:4619. Foudnation Trust, Gloucester, UK 2 Marmour M, Kellner U, Lai T et al. American Academy of Ophthalmology Statement; Recommendations on Correspondence to: Andrew Allard, Royal National Hospital Screening for Chloroquine and Hydroxychloroquine for Rheumatic Diseases, Upper Borough Walls, Bath Retinopathy (2016 Revision). Ophthalmology BA1 1RL, UK. E-mail: andrew.allard@nhs.net 2016;123:138694. ! The Author(s) 2018. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For permissions, please email: journals.permissions@oup.com Downloaded from https://academic.oup.com/rheumatology/advance-article-abstract/doi/10.1093/rheumatology/key085/4958704 by Ed 'DeepDyve' Gillespie user on 08 June 2018

Journal

RheumatologyOxford University Press

Published: Apr 2, 2018

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