ความชุกและลักษณะทางคลินิกของการเกิดภาวะจุดรับภาพชัดเสื่อมจาก Chloroquine และ Hydroxychloroquine ในผู้ป่วยที่มารับการรักษาที่โรงพยาบาลสุโขทัย

Saralai Yoosamran

Authors

Saralai Yoosamran Department of Ophthalmology, Sukhothai Hospital, Sukhothai Province

Keywords:

Photoreceptor degeneration, Maculopathy, Chloroquine, Hydroxychloroquine

Abstract

Background: Chloroquine (CQ) and hydroxychloroquine (HCQ) are associated with retinal toxicity, which can lead to irreversible macular damage and permanent visual impairment. Early detection through clinical screening is therefore essential to reduce the risk of vision loss among patients receiving these medications.

Objective: To determine the prevalence and clinical characteristics of chloroquine and hydroxychloroquine maculopathy among patients receiving treatment at Sukhothai Hospital.

Methods: A retrospective descriptive study was conducted using medical records of patients who received chloroquine or hydroxychloroquine at Sukhothai Hospital between January 1, 2019, and December 31, 2020. Data collected included demographic characteristics, drug dosage, duration of treatment, visual acuity, Ishihara color vision testing, spectral-domain optical coherence tomography (TD-OCT), central threshold visual field (CTVF) testing, and fundus photography.

Results: 180 patients who received CQ or HCQ and were screened for maculopathy were included. Mean age was 60.19 years (SD 11.87). Diagnoses were Lupus 18.75% and Rheumatoid arthritis 81.25%. From 180 patients, maculopathy was found in 8.89% (Chloroquine 17.02%, Hydroxychloroquine 6.02%). 56.25% received CQ or HCQ for 5-10 years, 43.75% for 1-5 years. No maculopathy was found in patients who received the drug less than 1 year. 62.50% received daily dose in high risk range. Most patients were moderate visual impairment 43.75%, no visual impairment 31.25%, and blindness 6.25%. All patients had color defect. CTVF and TD-OCT showed Perifoveal pattern 43.75%, Parafoveal pattern 31.25%, and Mixed pattern 25%. Only 2 of 16 showed Bull's eye pattern on fundus photography.

Conclusion: The prevalence of Chloroquine (CQ) and Hydroxychloroquine (HCQ) induced maculopathy in patients at Sukhothai hospital is 8.89% (prevalence of CQ maculopathy 17.02%, HCQ maculopathy 6.02%). Most patients received CQ or HCQ for more than 5 years and the shortest duration that caused maculopathy was 1 year 6 months. Almost all cases received high-risk doses for toxicity. Visual acuity was mostly moderate visual impairment and all patients had a color defect. CTVF and TD-OCT mostly showed Perifoveal pattern of maculopathy.

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