A Couturier1, A Giocanti-Aurégan2, B Dupas3, J-F Girmens4, Y Le Mer5, N Massamba6, E Barreau7, I Audo4. 1. Service d'ophtalmologie, hôpital Lariboisière, DHU vision et handicaps, université Paris 7-sorbonne Paris cité, AP-HP, 2, rue Ambroise-Paré, 75010 Paris, France. Electronic address: aude.couturier@aphp.fr. 2. Service d'ophtalmologie, DHU vision et handicaps, hôpital Avicenne, université Paris 13, AP-HP, 93000 Bobigny, France. 3. Service d'ophtalmologie, hôpital Lariboisière, DHU vision et handicaps, université Paris 7-sorbonne Paris cité, AP-HP, 2, rue Ambroise-Paré, 75010 Paris, France. 4. DHU vision et handicaps, centre hospitalier national ophtalmologique des Quinze-Vingts, Paris, France. 5. DHU vision et handicaps, fondation ophtalmologique Adolphe-de-Rothschild, Paris, France. 6. Service d'ophtalmologie, hôpital Pitié-Salpétrière, DHU vision et handicaps, université Paris 6, AP-HP, Paris, France. 7. Service d'ophtalmologie, hôpital Bicêtre, DHU vision et handicaps, université Paris Sud, AP-HP, 94270 Kremlin-Bicêtre, France.
Abstract
INTRODUCTION: Recommendations for screening for chloroquine (CQ) and hydroxychloroquine (HCQ) retinopathy have recently been changed by the American Academy of Ophthalmology, taking into account new published data on toxicity prevalence, risk factors, location of onset in the retina and the efficacy of screening tests. METHODS: Literature review. RESULTS AND DISCUSSION: The risk of developing CQ or HCQ retinopathy depends on the daily dose and duration of treatment. At recommended doses, the risk is<1 % at 5 years, <2 % at 10years but increases to about 20 % after 20years of treatment. The maximum recommended daily dose is 5.0mg/kg for HCQ and 2.3mg/kg for CQ. The two main risk factors are the daily dose and duration of treatment. The presence of kidney failure and treatment with tamoxifen are also significant risk factors. A baseline examination should be performed at the initiation of treatment to rule out pre-existing maculopathy. The screening is then annual and starts from the 5th year of treatment. The two tests recommended for screening are the automated visual field and spectral domain OCT. Multifocal ERG and autofluorescence fundus imaging are only carried out secondarily to confirm the pathology.
INTRODUCTION: Recommendations for screening for chloroquine (CQ) and hydroxychloroquine (HCQ) retinopathy have recently been changed by the American Academy of Ophthalmology, taking into account new published data on toxicity prevalence, risk factors, location of onset in the retina and the efficacy of screening tests. METHODS: Literature review. RESULTS AND DISCUSSION: The risk of developing CQ or HCQ retinopathy depends on the daily dose and duration of treatment. At recommended doses, the risk is<1 % at 5 years, <2 % at 10years but increases to about 20 % after 20years of treatment. The maximum recommended daily dose is 5.0mg/kg for HCQ and 2.3mg/kg for CQ. The two main risk factors are the daily dose and duration of treatment. The presence of kidney failure and treatment with tamoxifen are also significant risk factors. A baseline examination should be performed at the initiation of treatment to rule out pre-existing maculopathy. The screening is then annual and starts from the 5th year of treatment. The two tests recommended for screening are the automated visual field and spectral domain OCT. Multifocal ERG and autofluorescence fundus imaging are only carried out secondarily to confirm the pathology.