Posters

Ocular adverse effects and visual prognosis of long term hydroxychloroquine therapy

Poster Details

First Author: S.Parida INDIA

Co Author(s): A. Mishra   S. Parida   S. Mohanta              

Abstract Details

Purpose:

To compare the risk of hydroxychloroquine induced ocular toxicity between high & low risk groups(defined on the basis of AAO classification),to establish the role of  various multimodality imaging techniques as effective screening tools which would help in early diagnosis of ocular toxicity caused by long term use of hydroxychloroquine and create awareness among the patients and their treating physicians regarding the early signs of toxicity which would help in their  prevention  by dose modification and other measures thereof.

Setting:

RIO, eastern odisha, India-a tertiary care hospital

Methods:

A Comparative study was undertaken in a tertiary care hospital at eastern odisha, India from February 2016-July 2018 taking 220 (Age: 35-70 years) patients. Age, sex, indication of HCQ use, the daily dose, cumulative dose, duration of use and associated risk factors were recorded after taking informed consent from all the patients. A Complete ophthalmological examination was  done. Special objective tests were done including 24-2 & Central 10-2 visual field tests, SD-OCT, mf-ERG and FFA, wherever needed.

Results:

6(1.37%) out of 110 patients in the low risk group and 21(4.8%) out  of 110 patients showed ocular manifestations of HCQ toxicity. Pre-maculopathy was m/c ocular finding in low risk group, whereas high risk group mostly presented with features of retinal toxicity m/c being bullʼs eye maculopathy. Thinning of inner  retinal layers  excluding  RNFL   was most common SD-OCT finding in low risk patients, whereas there was thinning of outer retinal layers  in majority of high risk patients.BCVA  improved significantly in low risk group as compared to high risk group on cessation of HCQ for 1 year.

Conclusions:

The goal of screening is to detect early asymptomatic evidence of toxicity, though there are no clearly defined parameters for diagnosing early toxicity. Once toxicity is documented, discontinuation or dose modification should be considered in consultation with the patient and the internist or physician prescribing the drug. Patients should be advised that toxicity may progress despite discontinuation.Adherence to current ophthalmologic screening recommendations and proper dosing protocols may lower this risk.For patients with  low risk profile, annual screening  should begin 5 years after the start of treatment whereas in high risk  patients screening should begin 1year after the start of treatment.

Financial Disclosure:

None