Abstract

ARAUJO, Olga; PELEGRIN, Laura; ESPINOSA, Gerard  and  CERVERA, Ricard. Antimalarial-induced retinal toxicity. Rev.Colomb.Reumatol. [online]. 2021, vol.28, suppl.2, pp.132-143.  Epub May 04, 2024. ISSN 0121-8123.  https://doi.org/10.1016/j.rcreu.2021.05.010.

Antimalarials are first-line therapies in the management of systemic lupus erythematosus (SLE). Their immunomodulatory effects have been proven and are generally safe. Hydroxychloroquine (HCQ) has the best safety profile of these therapies. However, antimalarial retinopathy can lead to irreversible loss of vision. It is associated more frequently with the use of chloroquine (CQ) than with HCQbut, in general, the incidence of retinal toxicity is low. It is necessary to perform periodic ophthalmological tests from the beginning of treatment to detect patients with incipient retinopathy early, since at this stage withdrawing the drug leads to resolution of the condition. The main risk factors for retinopathy include duration of treatment, dose, chronic kidney disease, and pre-existing retinal or macular disease. The risk of toxicity is very low for doses of HCQ below 5 mg/kg of body weight, so the daily dose should not exceed this threshold. New detection modalities exist for the early detection of asymptomatic HCQ and CQ-induced retinopathy. The ophthalmological study demonstrates permanent retinal pigmentary deposits in the study of the eye fundus. The early detection tests are visual field (VF) together with spectral domain optical tomography (SD-OCT). The multifocal electroretinogram (mfERG) can provide objective corroboration for visual field, and fundus autofluorescence (FAF) can show the topography of lesions. The goal of all these examinations is to detect retinopathy before it is visible in the fundus. Given the low ini tial risk of HCQ or CQ retinopathy with an appropriate dose and absence of significant risk factors, annual screening may be postponed until 5 years of drug exposure have elapsed. Other than drug cessation, no diet or medical treatment has been shown to be effective in preventing, treating, or reducing the risk of antimalarial-induced retinopathy.

Keywords : Hydroxychloroquine; Chloroquine; Toxicity; Adverse effects; Diagnostic techniques; Ophtalmological; Lupus erythematosus systemic.

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