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Retinal toxicity related to hydroxychloroquine in patients with systemic lupus erythematosus and rheumatoid arthritis

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A Letter to the Editor to this article was published on 30 January 2018

Abstract

Purpose

To compare the retinal toxicity due to hydroxychloroquine (HCQ) use in patients with systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA) using multifocal electroretinography (mfERG), fundus autofluorescence (FAF) and optical coherence tomography (OCT).

Methods

Patients who were using HCQ due to SLE and RA, and healthy subjects evaluated in this study. Central foveal thickness (CFT), inner–outer segment (IS–OS) junction irregularity, retinal nerve fiber layer thickness, mfERG and FAF measurements were performed to evaluate retinal toxicity.

Results

Study included 35 eyes of 35 SLE patients, 40 eyes of 40 RA patients and 20 eyes of 20 healthy subjects. In SLE group, retinal abnormality was found in three eyes with mfERG, in one eye with FAF and in four eyes with OCT. In RA group, retinal abnormality was found in 10 eyes with mfERG, in five eyes with FAF and in nine eyes with OCT. A statistically significant difference was found with respect to mfERG between “eyes with abnormal responses and without abnormal responses” and “eyes with abnormal responses and controls” (p < 0.05). A statistically significant difference was found with respect to CFT between “eyes with IS–OS junction irregularities and without IS–OS junction irregularities” and “eyes with/without IS–OS junction irregularities and controls” (p < 0.05).

Conclusions

The use of HCQ seems to cause retinal toxicity more often in RA patients compared to SLE patients. For the early detection of retinal changes, OCT and mfERG can be used as screening tools due to their higher sensitivity rates compared to other tests.

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Authors and Affiliations

  1. Department of Ophthalmology, Ankara Training and Research Hospital, Sukriye, Ulucanlar St. No. 89, Altindag, 06340, Ankara, Turkey

    Hande Husniye Telek, Nilufer Yesilirmak, Gulten Sungur & Firdevs Ornek

  2. Department of Statistics, Gazi University Faculty of Sciences, Ankara, Turkey

    Yaprak Ozdemir

  3. Department of Rheumatology, Ankara Training and Research Hospital, Ankara, Turkey

    Nesibe Karahan Yesil

Authors
  1. Hande Husniye Telek
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  2. Nilufer Yesilirmak
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  3. Gulten Sungur
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  4. Yaprak Ozdemir
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  5. Nesibe Karahan Yesil
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  6. Firdevs Ornek
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Corresponding author

Correspondence to Nilufer Yesilirmak.

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Conflict of interest

All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership or other equity interest; and expert testimony or patent-licensing arrangements) or nonfinancial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

Statement of human rights

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Statement on the welfare of animals

This article does not contain any studies with animals performed by any of the authors.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Telek, H.H., Yesilirmak, N., Sungur, G. et al. Retinal toxicity related to hydroxychloroquine in patients with systemic lupus erythematosus and rheumatoid arthritis. Doc Ophthalmol 135, 187–194 (2017). https://doi.org/10.1007/s10633-017-9607-9

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  • DOI: https://doi.org/10.1007/s10633-017-9607-9

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