Evaluation of Ophthalmic Adverse Effects of Hydroxychloroquine in Pediatric Patients with Rheumatologic Diseases

Abstract

ydroxychloroquine (HCQ) is increasingly used in the management of a variety of autoimmune disorders, and has unfortunately been associated with irreversible visual loss due to retinal toxicity. Our study was aimed at screening for retinal damage resulting from HCQ therapy in pediatric SLE patients and assessment of the diagnostic accuracy of the investigational methods employed. This study included 45 SLE patients who were using HCQ in their treatment protocol for more than one year. They were 6 males (13%) and 39 females (87%).Their age ranged from 9 to 18 years old. Their weights ranged from 21 to 72 kg (Mean±SD =48.13 ± 12.27 kg), and their heights ranged from 85 to 175 cm (Mean±SD =142.53 ± 21.02 cm). The duration of HCQ intake ranged between 1 and 8 years, the cumulative dose was 228.3±117.6 gm, and the cumulative dose/kg was 4.8±2.3 gm. Forty five healthy children were enrolled as a control group. They were 19 males (42%) and 26 females (58%). Their ages matched statistically with the patients’ group. Our results revealed that approximately 29% (13 out of 45) of patients treated with HCQ had retinal toxicity as shown by the central 10-2 visual field test, and all of them had affection of the central/paracentral area. Three out of the 13 patients with visual field defect had reduced retinal thickness by OCT examination denoting reduced central macular thickness (CMT) (P = 0.037 and 0.034 for right and left eyes, respectively).