Article Figures & Data
Figures
- Figure 1.
Ocular findings of (A) pericentral pattern, (B) mixed pattern, and (C) parafoveal pattern of hydroxychloroquine retinal toxicity. (A) Top to bottom: Superior field loss is located peripherally in pattern deviation plot (10-2 visual field). FAF image shows broad range of hyperautofluorescence in inferior retina. SD-OCT image shows loss of photoreceptor layer in pericentral area (arrow). (B) Top to bottom: 10-2 visual fields (threshold and pattern deviation plot) are showing full ring scotomas. FAF image shows ring-shaped hyperautofluorescence in parafoveal area (dashed curves) with diffuse hyperautofluorescence in pericentral area (dashed curves). SD-OCT image shows disruption of photoreceptor layer with loss of outer nuclear layer in both parafoveal and pericentral retina (arrows). RPE damage is combined at the extrafoveal region. (C) Top to bottom: 10-2 visual fields (threshold and pattern deviation plot) are showing patchy parafoveal scotomas. Hyperautofluorescence are shown at a region just inferior to macula on FAF image. SD-OCT image shows parafoveal disruption of photoreceptor layer with loss of outer nuclear layer (arrow). RPE damage is suspected within the parafoveal retina. FAF: fundus autofluorescence; SD-OCT: spectral domain optical coherence tomography; RPE: retinal pigment epithelium.
- Figure 2.
Distribution of study participants according to duration and daily dose per body weight of hydroxychloroquine. Red stars and black dots indicate patients with and without retinal toxicity, respectively. Dashed lines indicate 5 years of duration (X axis) and a 5-mg/kg daily dose per body weight (Y axis).
Tables
- Table 1.
Comparison of characteristics between patients with and without retinal toxicity.
Variable Retinal Toxicity, n = 17 No Retinal Toxicity, n = 106 p Female, n (%) 16 (94.1) 102 (96.2) 1.000 Age, yrs, mean (SD) 56.2 (11.6) 50.3 (11.2) 0.045 Weight, kg, median (IQR) 54.0 (46.0–57.0) 54.0 (50.0–59.0) 0.297 BMI, kg/m2, mean (SD) 21.5 (2.7) 21.8 (3.0) 0.718 Drug use Daily HCQ dose, mg, median (IQR) 400.0 (400.0–400.0) 360.9 (281.9–400.0) 0.019 Daily HCQ dose/weight, mg/kg, mean (SD) 7.2 (1.2) 6.3 (1.7) 0.035 Duration of HCQ use, yrs, mean (SD) 15.2 (5.0) 9.2 (4.6) < 0.001 Cumulative HCQ dose, g, median (IQR) 1866.4 (1458.2–2806.0) 1055.3 (718.0–1446.8) < 0.001 Primary indication, n (%) Systemic lupus erythematosus 8 (47.1) 62 (58.5) 0.535 Rheumatoid arthritis 9 (52.9) 38 (35.8) 0.281 Others (Sjögren syndrome, MCTD) 0 (0) 6 (5.7) 0.690 Comorbid condition, n (%) Kidney disease 4 (23.5) 4 (3.8) 0.011 Liver disease 0 (0) 5 (4.7) 0.800 Hypertension 6 (35.3) 11 (10.4) 0.017 Diabetes mellitus 0 (0) 3 (2.8) 1.000 IQR: interquartile range; BMI: body mass index; HCQ: hydroxychloroquine; MCTD: mixed connective tissue disease.
No. Diagnosis Sex/age, Yrs Daily Dose/BW, mg/kg Duration of Use, Yrs Visual Field SD-OCT FAF Severity Pericentral pattern 1 RA F/54 8.9 12.8 Partial ring scotoma Thinning of ONL Abnormal Moderate 2 SLE F/55 6.5 20.1 Unremarkable Disruption of IS/OS Abnormal Early 3 SLE F/34 5.1 21.9 Complete ring scotoma Thinning of ONL Abnormal Moderate 4 SLE F/52 8.3 19.5 Defect in pattern deviation Disruption of IS/OS Abnormal Moderate 5 SLE F/56 9.1 7.3 Partial ring scotoma Thinning of ONL Abnormal Moderate 6 SLE F/39 7.0 20.6 Patchy pericentral ring Thinning of ONL Abnormal Moderate 7 SLE F/54 7.4 6.7 Defect in pattern deviation Disruption of IS/OS Normal Early 8 RA F/68 7.0 15.2 Complete ring scotoma Thinning of ONL Abnormal Moderate 9 RA F/51 7.1 13.0 Unremarkable Disruption of IS/OS Abnormal Early 10 SLE F/40 4.9 18.1 Defect in pattern deviation Disruption of IS/OS Abnormal Moderate 11 RA F/77 9.1 11.9 Defect in pattern deviation Disruption of IS/OS Abnormal Early 12 RA F/57 5.5 14.8 Defect in pattern deviation Disruption of IS/OS Abnormal Moderate 13 RA F/55 7.0 13.3 Patchy pericentral ring Thinning of ONL Abnormal Moderate Mixed pattern 14 RA F/71 7.1 20.5 Complete ring scotoma Thinning of ONL Abnormal Severe 15 SLE F/62 7.5 20.1 Complete ring scotoma Thinning of ONL Abnormal Severe Parafoveal pattern 16 RA F/71 7.1 15.9 Complete ring scotoma Thinning of ONL Abnormal Severe 17 RA M/60 7.0 7.1 Patchy paracentral scotoma Thinning of ONL Abnormal Moderate BW: body weight; SD-OCT: spectral domain optical coherence tomography; FAF: fundus autofluorescence; RA: rheumatoid arthritis; SLE: systemic lupus erythematosus; ONL: outer nuclear layer; IS/OS: inner segment/outer segment.
- Table 3.
Factors associated with retinal toxicity (multivariable logistic regression analysis).
Variable Adjusted OR (95% CI) p Duration of HCQ use in 5-yr increments 4.71 (2.18–10.15) < 0.001 Daily HCQ dose in 100-mg increments 3.34 (1.03–10.80) 0.044 Kidney disease 8.56 (1.15–64.00) 0.036 Hypertension 2.39 (0.54–10.58) 0.249 Age, yrs 1.05 (0.98–1.12) 0.154 Weight, kg 0.94 (0.87–1.03) 0.166 HCQ: hydroxychloroquine.
