Ronald B Melles1, Michael F Marmor2. 1. Department of Ophthalmology, Redwood City Medical Center, Kaiser Permanente Northern California, Redwood City, California. Electronic address: Ronald.Melles@kp.org. 2. Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California.
Abstract
PURPOSE: To describe patterns of hydroxychloroquine retinopathy distinct from the classic parafoveal (bull's eye) maculopathy. DESIGN: Retrospective case series. PARTICIPANTS: Patients from a large multi-provider group practice and a smaller university referral practice diagnosed with hydroxychloroquine retinopathy. Patients with widespread or "end-stage" retinopathy were excluded. METHODS: Review of ophthalmic studies (fundus photography, spectral-domain optical coherence tomography, fundus autofluorescence, multifocal electroretinography, visual fields) and classification of retinopathy into 1 of 3 patterns: parafoveal (retinal changes 2°-6° from the fovea), pericentral (retinal changes ≥ 8° from the fovea), or mixed (retinal changes in both parafoveal and pericentral areas). MAIN OUTCOME MEASURES: Relative frequency of different patterns of hydroxychloroquine retinopathy and comparison of risk factors. RESULTS: Of 201 total patients (18% Asian) with hydroxychloroquine retinopathy, 153 (76%) had typical parafoveal changes, 24 (12%) also had a zone of pericentral damage, and 24 (12%) had pericentral retinopathy without any parafoveal damage. Pericentral retinopathy alone was seen in 50% of Asian patients but only in 2% of white patients. Patients with the pericentral pattern were taking hydroxychloroquine for a somewhat longer duration (19.5 vs. 15.0 years, P < 0.01) and took a larger cumulative dose (2186 vs. 1813 g, P = 0.02) than patients with the parafoveal pattern, but they were diagnosed at a more severe stage of toxicity. CONCLUSIONS: Hydroxychloroquine retinopathy does not always develop in a parafoveal (bull's eye) pattern, and a pericentral pattern of damage is especially prevalent among Asian patients. Screening practices may need to be adjusted to recognize pericentral and parafoveal hydroxychloroquine retinopathy.
PURPOSE: To describe patterns of hydroxychloroquineretinopathy distinct from the classic parafoveal (bull's eye) maculopathy. DESIGN: Retrospective case series. PARTICIPANTS: Patients from a large multi-provider group practice and a smaller university referral practice diagnosed with hydroxychloroquineretinopathy. Patients with widespread or "end-stage" retinopathy were excluded. METHODS: Review of ophthalmic studies (fundus photography, spectral-domain optical coherence tomography, fundus autofluorescence, multifocal electroretinography, visual fields) and classification of retinopathy into 1 of 3 patterns: parafoveal (retinal changes 2°-6° from the fovea), pericentral (retinal changes ≥ 8° from the fovea), or mixed (retinal changes in both parafoveal and pericentral areas). MAIN OUTCOME MEASURES: Relative frequency of different patterns of hydroxychloroquineretinopathy and comparison of risk factors. RESULTS: Of 201 total patients (18% Asian) with hydroxychloroquineretinopathy, 153 (76%) had typical parafoveal changes, 24 (12%) also had a zone of pericentral damage, and 24 (12%) had pericentral retinopathy without any parafoveal damage. Pericentral retinopathy alone was seen in 50% of Asian patients but only in 2% of white patients. Patients with the pericentral pattern were taking hydroxychloroquine for a somewhat longer duration (19.5 vs. 15.0 years, P < 0.01) and took a larger cumulative dose (2186 vs. 1813 g, P = 0.02) than patients with the parafoveal pattern, but they were diagnosed at a more severe stage of toxicity. CONCLUSIONS:Hydroxychloroquineretinopathy does not always develop in a parafoveal (bull's eye) pattern, and a pericentral pattern of damage is especially prevalent among Asian patients. Screening practices may need to be adjusted to recognize pericentral and parafoveal hydroxychloroquineretinopathy.
Authors: Mustafa Iftikhar; Ramandeep Kaur; April Nefalar; Bushra Usmani; Saleema Kherani; Isra Rashid; Etienne Schönbach; Michelle Petri; Hendrik P N Scholl; Syed M Shah Journal: Retina Date: 2019-03 Impact factor: 4.256
Authors: Nathalie Costedoat-Chalumeau; Bertrand Dunogué; Gaëlle Leroux; Nathalie Morel; Moez Jallouli; Véronique Le Guern; Jean-Charles Piette; Antoine P Brézin; Ronald B Melles; Michael F Marmor Journal: Clin Rev Allergy Immunol Date: 2015-12 Impact factor: 8.667