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October 10, 2019
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RPE damage continues in patients with severe HCQ retinopathy after drug cessation

Severe retinal pigment epithelial damage after long-term drug cessation in patients with hydroxychloroquine retinopathy may lead to injury that chronically destabilizes cellular function, according to findings published in Retina.

Perspective from Kuniyoshi Kanai, OD, FAAO

Brandon H. Pham, BS, and Michael F. Marmor, MD, sought to characterize the stability or progression of different stages of hydroxychloroquine (HCQ) retinopathy up to 20 years after patients stopped taking the drug.

“Patients with retinopathy detected at early stages seemed to stabilize with little risk of central vision loss, whereas those with preexisting damage to the retinal pigment epithelium [RPE] showed progressive photoreceptor damage,” Pham, of the Stanford University School of Medicine, and Marmor, of the Byers Eye Institute at Stanford University, wrote. “However, it remains unclear whether the apparent stability of milder cases would last over longer periods and whether more severe cases would eventually stabilize.”

The researchers examined the findings of 13 patients with initial HCQ retinopathy with early, moderate and or severe classifications. Patients who were off of HCQ for as long as 14 years at initial examination had a 5- to 8-year follow-up with repeated fundus autofluorescence and spectral domain OCT imaging.

Pham and colleagues found that patients with early and moderate classifications stabilized in fundus appearance, foveal thickness, ellipsoid zone line length and visual acuity for 9 years after HCQ use. In patients with severe HCQ retinopathy, a continual loss of the parameters was found for up to 20 years after use.

RPE damage found in initial examination predicted progressive retinopathy over many years, the researchers wrote.

Pham and colleagues said their findings stress the importance of early detection to minimize progression and visual loss. – by Earl Holland Jr.


Disclosures: The authors report no relevant financial disclosures.