Advertisement

International Ophthalmology

, Volume 33, Issue 6, pp 627–634 | Cite as

Chloroquine and hydroxychloroquine retinopathy-related risk factors in a Turkish cohort

  • Sevil Ari Yaylali
  • Fariz Sadigov
  • Hasan Erbil
  • Asiye Ekinci
  • Aylin Ardagil Akcakaya
Original Paper

Abstract

To evaluate the role of previously reported risk factors on developing retinopathy in patients treated with chloroquine (CQ) and hydroxychloroquine (HCQ). Ophthalmologic examination, visual field testing, and spectral domain-optical coherence tomography were performed in 31 patients treated with CQ and HCQ. Toxicity diagnosis was proven by electrophysiological assessment. The risk factors reported by the American Academy of the Ophthalmology (AAO) were compared between patients with (n = 5) and without toxicity (n = 26) findings. Risk score was calculated for each patient. CQ daily overdose per actual body weight was significantly higher in affected patients. There was no statistically significant difference between groups concerning risk score, estimated cumulative dose of CQ, daily dose of HCQ and CQ per lean body weight, daily overdose of CQ per lean body weight and actual body weight (>3 mg/kg). The cumulative dose of HCQ was significantly higher in non-affected patients. The risk factors reported by the AAO might not be applicable to all CQ- and HCQ-treated patients. Different risk factors not yet reported may play a role in the development of CQ and HCQ retinopathy.

Keywords

Chloroquine Hydroxychloroquine Retinopathy Risk factors Turkish cohort 

Notes

Conflict of interest

The authors have no proprietary or commercial interest in any material discussed in this article.

References

  1. 1.
    Bernstein HN (1991) Ocular safety of hydroxychloroquine. Ann Ophthalmol 23(8):292–296PubMedGoogle Scholar
  2. 2.
    Mavrikakis I, Sfikakis PP, Mavrikakis E et al (2003) The incidence of irreversible retinal toxicity in patients treated with hydroxychloroquine: a reappraisal. Ophthalmology 110(7):1321–1326PubMedCrossRefGoogle Scholar
  3. 3.
    Marmor MF, Carr RE, Easterbrook M, Farjo AA, Mieler WF (2002) American Academy of Ophthalmology. Recommendations on screening for chloroquine and hydroxychloroquine retinopathy: a report by the American Academy of Ophthalmology. Ophthalmology 109(7):1377–1382PubMedCrossRefGoogle Scholar
  4. 4.
    Lyons JS, Severns ML (2009) Using multifocal ERG ring ratios to detect and follow plaquenil retinal toxicity: a review: review of mfERG ring ratios in plaquenil toxicity. Doc Ophthalmol 118(1):29–36PubMedCrossRefGoogle Scholar
  5. 5.
    Bergholz R, Schroeter J, Rüther K (2010) Evaluation of risk factors for retinal damage due to chloroquine and hydroxychloroquine. Br J Ophthalmol 94(12):1637–1642PubMedCrossRefGoogle Scholar
  6. 6.
    Shichiri M, Kono N, Shimanaka Y et al (2012) A novel role for α-tocopherol transfer protein (α-TTP) in protecting against chloroquine toxicity. J Biol Chem 287(4):2926–2934PubMedCrossRefGoogle Scholar
  7. 7.
    Shroyer NF, Lewis RA, Lupski JR (2001) Analysis of the ABCR (ABCA4) gene in 4-aminoquinoline retinopathy: is retinal toxicity by chloroquine and hydroxychloroquine related to Stargardt disease? Am J Ophthalmol 131(6):761–766PubMedCrossRefGoogle Scholar
  8. 8.
    Marmor MF, Kellner U, Lai TY, Lyons JS, Mieler WF (2011) American Academy of Ophthalmology. Revised recommendations on screening for chloroquine and hydroxychloroquine retinopathy. Ophthalmology 118(2):415–422PubMedCrossRefGoogle Scholar
  9. 9.
    Michaelides M, Stover NB, Francis PJ, Weleber RG (2011) Retinal toxicity associated with hydroxychloroquine and chloroquine: risk factors, screening, and progression despite cessation of therapy. Arch Ophthalmol 129(1):30–39PubMedCrossRefGoogle Scholar
  10. 10.
    Sundelin SP, Terman A (2002) Different effects of chloroquine and hydroxychloroquine on lysosomal function in cultured retinal pigment epithelial cells. APMIS 110(6):481–489PubMedCrossRefGoogle Scholar
  11. 11.
    Shroyer NF, Lewis RA, Lupski JR (2001) Analysis of the ABCR (ABCA4) gene in 4-aminoquinoline retinopathy: is retinal toxicity by chloroquine and hydroxychloroquine related to Stargardt disease? Am J Ophthalmol 131(6):761–766PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media Dordrecht 2013

Authors and Affiliations

  • Sevil Ari Yaylali
    • 1
  • Fariz Sadigov
    • 1
  • Hasan Erbil
    • 1
  • Asiye Ekinci
    • 1
  • Aylin Ardagil Akcakaya
    • 1
  1. 1.Department of OphthalmologyIstanbul Medeniyet University Goztepe Educational and Research HospitalIstanbulTurkey

Personalised recommendations