Evaluation of maculopathy in patients using hydroxychloroquine

Objectives: To determine length of hydroxychloroquine use and cumulative dose and evaluate the ocular effects by 10-2 central visual field test, microperimetry (MP), color fundus photography, optical coherence tomography (OCT), and fundus autofluorescence (FAF) in hydroxychloroquine users. Materials and Methods: Patients who used hydroxychloroquine continuously for at least 2 years for various connective tissue diseases were included in the study. A total of 300 eyes of 150 patients aged 19-78 years who were followed due to risk of developing hydroxychloroquine maculopathy in the İstanbul University İstanbul Faculty of Medicine Ophthalmology Department between the years 1995-2017 were evaluated. Best corrected visual acuity (BCVA), biomicroscopic, and fundoscopic examination were performed at all visits. MP, FAF, OCT, fundus photography, and central 10-2 visual field examinations were performed 3 times at 6-month intervals. Results: The mean age of patients was 48.9±10.8 years; 141 (94%) patients were female and 9 (6%) were male. The mean duration of hydroxychloroquine use was 10.5±6.4 (2-30) years. Fifty-six patients had been using the drug for 5 years or less. The mean cumulative drug dose was 754.7±447.2 (146-1825) g. Mean BCVA was 0.02±0.08 LogMAR at all follow-up visits (p=0.999). Mean MP values at the first, second, and third examinations were 14.07±3.24 dB, 14.18±3.35 dB, and 14.54±2.79 dB, respectively (p>0.05). Mean central macular thickness was 221.9±19.8 µm at initial examination, 221.8±19.9 µm at the second visit, and 221.8±19.8 µm at the final visit (p=0.113). There was a weak negative correlation between age and MP values at all three visits (visit 1: p=0.003, r=-0.170; visit 2: p=0.001, r=-0.185, visit 3: p=0.011, r=-0.146). There was statistically significant relationship between MP values and hydroxychloroquine length of use and cumulative dose (p=0.027 and p=0.049, respectively). Duration of use was not associated with changes in 10/2 visual field (p=0.124). There were significant relationships between alterations in FAF and hydroxychloroquine length of use and cumulative dose (p=0.027 and p=0.049, respectively). Conclusion: FAF alterations were significantly associated with duration of hydroxychloroquine use and cumulative dose. As objective methods are more reliable, examinations such as FAF can be recommended as auxiliary methods in the follow-up and early detection of toxic maculopathy. © 2019 by Turkish Ophthalmological Association.