CURRENT RECOMMENDATIONS ON SCREENING FOR HYDROXYCHLOROQUINE OR CHLOROQUINE RETINOPATHY

Abstract
Chloroquine and hydroxychloroquine are used widely to treat rheumatoid diseases, and have the potential to cause serious retinal toxicity. However, toxicity is very rare at doses of chloroquine below 3.0 mg/kg/day or doses of hydroxychloroquine below 6.5 mg/kg/day. Recent recommendations by the American Academy of Ophthalmology state that patients using doses below these levels should have a baseline retinal exam, but if there are no other risk factors annual testing need not begin until after 5 years of usage. After 5 years, or with added risk factors (retinal disease, age over 60 years, liver or kidney disease, obesity), testing should be performed annually and include central field testing with Amsler grid or automated fields. The latest published reports on the toxicity of these drugs have supported these recommendations. Newer studies have also shown that the multifocal electroretinogram can document focal retinal damage over the bull's-eye pattern of pigmentary loss when there is toxicity. This test may prove to be a useful tool in the evaluation of early or uncertain toxicity.

Key words
Chloroquine, electroretinogram, hydroxychloroquine, retinal toxicity, screening

Bibliografía del artículo

1. Marmor MF, Carr RE, Easterbrook M, Farjo AA, Mieler WF (for the American Academy of Ophthalmology): Recommendations on screening for chloroquine and hydroxychloroquine retinopathy. Ophthalmol 109:1377-1382, 2002.
2. Browning DJ. Hydroxychloroquine and chloroquine retinopathy: Screening for drug toxicity. Am J Ophthalmol 2002;133:649-656.
3. Mavrikakis I, Sfikakis PP, Mavrikakis E, Rougas K, Nikolaou A, Kostopoulos C, Mavrikakis M. The incidence of irreversible retinal toxicity in patients treated with hydroxychloroquine. Ophthalmol 2003;110:1321-1326.
4. Shroyer NF, Lewis RA, Lupski JR. Analysis of the ABCR (ABCA4) gene in 4-aminoquinoline retinopathy: Is retinal toxicity by chloroquine and hydroxychloroquine related to Stargardt disease Am J Ophthalmol 2001;131:761-766.
5. Cavagna L, Rossi P, Bogliolo L, Antoniazzi E, Gelmi C, Caporali R, Montecucco C. Early electroretinografic changes in elderly RA patients treated with hydroxychloroquine. J Rheumatol 2002;29:1665-1670.
6. Tzekov RT, Serrato A, Marmor MF. ERG findings in patients using hydroxychloroquine. Doc Ophthalmol, In Press.
7. Marmor MF, Hood DC, Keating D, Kondo M, Seeliger MW, Miyake Y (for the International Society for Clinical Electrophysiology of Vision): Guidelines for basic multifocal electroretinography (mfERG). Doc Ophthalmol 2003; 106:105-15. [available also on web: www.iscev.org].
8. Kellner U, Kraus H, Foerster MH. Multifocal ERG in chloroquine retinopathy: Regional variance of retinal dysfunction. Graefes Arch Clin Exp Ophthalmol 2000;238:94-97.
9. Maturi RK, Folk JC, Nichols B, Oetting 9:26:37 AM, Kardon RH. Hydroxychloroquine retinopathy. Arch Ophthalmol 1999;117:1262-1263.
10. Penrose PJ, Tzekov RT, Sutter EE, Fu AD, Allen Jr AW, Fung WE, Oxford KW. Multifocal electroretinography (mfERG) evaluation for early detection of retinal dysfunction in patients taking hydroxychloroquine (HCQ). Retina 2003;23:503-512.
11. So SC, Hedges TR, Schuman JS, Quireza ML. Ophthalmic Surg Lasers Imaging 2003;34:251-258.
12. Yu M, Maturi RK. Multifocal electroretinography may be an early indicator of hydroxychloroquine toxicity. 2002 ARVO presentation (see www.arvo.org).

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