A new study adds to the growing body of literature supporting the importance of detecting hydroxychloroquine (HCQ) retinopathy early to minimize the risk of progression and foveal involvement in patients with pericentral retinopathy. The research team from Korea also found pericentral HCQ retinopathy trended toward severity-dependent progression, with moderate cases usually progressing and severe cases being at greater risk of centripetal progression that threatened the fovea.
The multicenter, retrospective cohort investigation enrolled 80 eyes—including 60 with a pericentral pattern—of 41 Korean patients with HCQ retinopathy who were followed at least two years after drug cessation.
Patients were screened for HCQ retinopathy using spectral-domain or swept-source OCT, fundus autofluorescence and visual field (VF) testing. Retinopathy progression on OCT was defined as increased length of the ellipsoid zone defect, decreased distance from the fovea to the photoreceptor defects or newly developed or enlarged retinal pigment epithelium defects. On fundus autofluorescence, progression was defined as an increase in the area of hyperautofluorescence or hypoautofluorescence. Functional progression was defined as regression of less than zero dB/year for mean deviation and zero or greater dB/year for pattern standard deviation based on three or more VF tests.
Approximately one-third of eyes with early pericentral retinopathy showed limited progression during the short-term period after drug cessation, but they subsequently had stable or improved photoreceptors.
Most eyes with moderate pericentral retinopathy progressed continuously, particularly once they converted to the severe stage, where eyes showed progressive damage throughout the follow-up period.
In all severity groups, the rates of retinal thinning decreased over time. In eyes with pericentral retinopathy that progressed, circumferential enlargement of retinal damage was prominent in earlier stages, whereas centripetal enlargement of the ring-shaped lesion was noted in advanced stages. Additionally, functional progression, which was noted in 58.7% of pericentral eyes, corresponded with structural progression.
Ahn SJ, Seo EJ, Kim KE, et al. Long-term progression of pericentral hydroxychloroquine retinopathy. Ophthalmology. October 28, 2020. [Epub ahead of print].