![]() ![]() The AAO guidelines suggest that all patients beginning long-term hydroxychloroquine or chloroquine therapy have a baseline examination to establish a record of baseline fundus or nerve abnormalities. As reported by Marmor et al, the risk at this dosage is less than 1% up to 5 years, less than 2% up to 10 years, and almost 20% after 20 years. 3 At these doses, the risk of toxicity is minimal in early years but increases with duration of use. AAO GUIDELINESĪAO recommendations published in 2016 suggested that daily dosage of hydroxychloroquine should be less than 5.0 mg/kg of real body weight. A parafoveal early bulls-eye maculopathy is evident in both eyes. Fundus photography of the right (A) and left eye (B) in a patient with early hydroxychloroquine toxicity is shown. 3 Additional factors that can precipitate early toxicity are concomitant renal disease and use of tamoxifen. 1 Toxicity is thought to be dependent on cumulative total dose. The estimated risk of hydroxychloroquine retinopathy in patients on chronic hydroxychloroquine therapy ranges from 0.4% to 8.0%. 1 Because of this theorized accumulation, hydroxychloroquine toxicity can progress despite cessation of the medication. The mechanism of toxicity is unknown but is thought to be due to accumulation of the medication in the retinal pigment epithelium (RPE), leading to subsequent RPE degeneration. Microperimetry and adaptive optics are undergoing studies to confirm their usefulness in hydroxychloroquine toxicity screening.Ĭlinically, this manifests as a bulls-eye maculopathy, although these fundus changes are evident only in the later stages of disease (Figure 1).No single imaging platform can confirm the presence of hydroxychloroquine toxicity, but a combination of imaging tests can provide ample evidence for diagnosis. ![]() Long-term use of hydroxychloroquine sulfate may result in parafoveal retinal toxicity.When macular edema is caused by vitreous pulling on the macula, a procedure called a vitrectomy may be needed to restore the macula to its normal (lying flat) shape. The goal is to stabilize vision by sealing off leaking blood vessels With this tiny laser pulses are applied to the areas of fluid leakage around the macula. When macular edema is caused by inflammation, steroids can be given either as drops,tablets or as injections into the eye.Īnti Vascular Endothelial Growth Factor( Anti-VEGF)medicines given as intravitreal injections into the eye helps to reduce the growth of abnormal blood vessels in the retina, and also decreases leaking from blood vessels. Non Steroidal anti inflammatory drugs can be given as eye drops to cure the swelling. A series of photographs is taken of the retina as the dye passes through its blood vesselsįirst and foremost is addressing the underlying cause of the macular edema, and the related leakage and retinal swelling. This helps your doctor find leakage and measure swelling of the macula.It can also be used to follow the response to treatmentįor this test, fluorescein dye is injected into a peripheral vein in the hand or forearm. It scans the retina and provides very detailed images of its thickness. Further tests can be ordered to document and measure the thickness of the macula. A routine dilated fundus examination by the ophthalmologist aids in the diagnosis. ![]()
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