Dong Hoon Lee1, Ronald B Melles2, Soo Geun Joe3, Joo Yong Lee3, June-Gone Kim3, Chang-Keun Lee4, Bin Yoo4, Bon San Koo4, Jee Taek Kim5, Michael F Marmor6, Young Hee Yoon7. 1. Department of Ophthalmology, The Eagle Eye Clinic, Bundang-gu, Seongnam-si, Gyeonggi-do, Korea. 2. Department of Ophthalmology, Kaiser Permanente, Redwood City Medical Center, Redwood City, California. 3. Department of Ophthalmology, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Korea. 4. Department of Rheumatology, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Korea. 5. Department of Ophthalmology, College of Medicine, Chung-Ang University, Seoul, Korea. 6. Department of Ophthalmology, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California. 7. Department of Ophthalmology, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Korea. Electronic address: yhyoon@amc.seoul.kr.
Abstract
PURPOSE: A pericentral pattern of hydroxychloroquine (HCQ) retinopathy recently has been recognized in the United States in patients of Asian heritage. We report on an investigation of this pericentral retinopathy within a Korean population. DESIGN: Retrospective, observational study. PARTICIPANTS: Patients taking HCQ who were referred to ophthalmology for screening of HCQ retinopathy. METHODS: The medical records of patients were reviewed, including spectral domain optical coherence tomography, fundus autofluorescence, and visual fields. MAIN OUTCOME MEASURES: Frequency of pericentral pattern of HCQ retinopathy and features of progression. RESULTS: Among 218 patients referred, 9 (4.1%) were diagnosed with toxicity. Of these, 8 had a predominantly pericentral pattern of retinal change, whereas only 1 had the classic parafoveal distribution of retinal damage. Progression of retinopathy was documented in 3 patients followed more than 12 months while taking HCQ. No progression was seen in 2 patients without retinal pigment epithelial (RPE) damage who were followed for at least 12 months after discontinuation of HCQ. CONCLUSIONS: We found that a pericentral pattern of HCQ retinopathy was predominant among Korean patients, rather than the traditional (bull's eye) parafoveal pattern of damage. Retinopathy progressed while on the drug, but the progression stopped in patients with toxicity detected before RPE damage. These observations suggest the need for new approaches when screening for HCQ toxicity in Asian patients.
PURPOSE: A pericentral pattern of hydroxychloroquine (HCQ) retinopathy recently has been recognized in the United States in patients of Asian heritage. We report on an investigation of this pericentral retinopathy within a Korean population. DESIGN: Retrospective, observational study. PARTICIPANTS: Patients taking HCQ who were referred to ophthalmology for screening of HCQ retinopathy. METHODS: The medical records of patients were reviewed, including spectral domain optical coherence tomography, fundus autofluorescence, and visual fields. MAIN OUTCOME MEASURES: Frequency of pericentral pattern of HCQ retinopathy and features of progression. RESULTS: Among 218 patients referred, 9 (4.1%) were diagnosed with toxicity. Of these, 8 had a predominantly pericentral pattern of retinal change, whereas only 1 had the classic parafoveal distribution of retinal damage. Progression of retinopathy was documented in 3 patients followed more than 12 months while taking HCQ. No progression was seen in 2 patients without retinal pigment epithelial (RPE) damage who were followed for at least 12 months after discontinuation of HCQ. CONCLUSIONS: We found that a pericentral pattern of HCQ retinopathy was predominant among Korean patients, rather than the traditional (bull's eye) parafoveal pattern of damage. Retinopathy progressed while on the drug, but the progression stopped in patients with toxicity detected before RPE damage. These observations suggest the need for new approaches when screening for HCQtoxicity in Asian patients.
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