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Ocular findings in Japanese patients with hydroxychloroquine retinopathy developing within 3 years of treatment

  • Clinical Investigation
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Abstract

Purpose

To describe the characteristics of Japanese patients with hydroxychloroquine (HCQ) retinopathy developing within 3 years of treatment outset.

Study design

Retrospective case series

Methods

Three patients with HCQ retinopathy developing within 3 years of treatment outset have been identified in Japan since HCQ became available in 2015. Their medical charts, containing optical coherence tomography (OCT), fundus autofluorescence imaging, and visual field tests, were reviewed.

Results

The treatment durations and cumulative doses until onset were 29–36 months and 182–326 g, respectively. The first patient had possible pre-existing maculopathy, although the abnormalities were ambiguous. The second and third patients had impaired renal function. The patients did not complain of severe visual disturbance at diagnosis, but visual field loss and disruption of the outer retinal segments consisting of a parafoveal pattern in the first case and a pericentral pattern (localized, 8 or more degrees from the center of the fovea) in the second and third cases were clearly observed on OCT. Even after HCQ discontinuation, their retinopathy showed slight progression on the visual field tests and OCT images. A blood sample was obtained from 1 patient on the day after HCQ discontinuation, and the whole blood level of HCQ was measured using validated liquid chromatography-tandem mass spectrometry. The HCQ level 27 h after the last dose was high, at 2240 ng/mL (suggested threshold > 1733 ng/mL).

Conclusion

Ophthalmologic screening from the initiation of HCQ treatment detected 3 cases of HCQ retinopathy developing within 3 years of treatment outset, including a patient with a high blood level of HCQ.

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Acknowledgements

Naoto Yokogawa received a research grant from the Tokyo Metropolitan Government (the hydroxychloroquine retinopathy support program: https://www.fuchu-hp.fuchu.tokyo.jp/about/department/rheumatism/hsupport/). We are indebted to Mr James R. Valera for his assistance in editing the manuscript.

Author information

Authors and Affiliations

  1. Department of Ophthalmology, Kawasaki Municipal Hospital, Kanagawa, Japan

    Hiroko Ozawa

  2. Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan

    Hiroko Ozawa & Kaoru Fujinami

  3. Department of Ophthalmology, Nagoya University Graduate School of Medicine, 65 Tsuruma-cho, Showa-ku, Nagoya, 466-8550, Japan

    Shinji Ueno

  4. Department of Ophthalmology, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan

    Akiko Ohno-Tanaka

  5. Department of Ophthalmology, Chubu Rosai Hospital, Nagoya, Japan

    Takao Sakai

  6. Division for Evaluation and Analysis of Drug Information, Faculty of Pharmacy, Keio University, Tokyo, Japan

    Masayuki Hashiguchi

  7. Department of Pharmaceutics and Pharmacometrics, School of Pharmacy, Shujtsu University, Okayama, Japan

    Mikiko Shimizu

  8. National Institute of Sensory Organs, National Hospital Organization Tokyo Medical Center, Tokyo, Japan

    Kaoru Fujinami

  9. Department of Genetics, UCL Institute of Ophthalmology, London, UK

    Kaoru Fujinami

  10. Department of Ophthalmology, Hanyang University Hospital, Seoul, Korea

    Seong Joon Ahn

  11. Department of Ophthalmology, Mie University Graduate School of Medicine, Tsu, Japan

    Mineo Kondo

  12. Charlotte, Eye, Ear, Nose, and Throat Associates, Charlotte, NC, USA

    David J. Browning

  13. Department of Ophthalmology, Saitama Medical University, Saitama, Japan

    Kei Shinoda

  14. Department of Rheumatic Diseases, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan

    Naoto Yokogawa

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  1. Hiroko Ozawa
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  8. Seong Joon Ahn
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  9. Mineo Kondo
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Corresponding author

Correspondence to Shinji Ueno.

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Conflicts of interest

H. Ozawa, None; S. Ueno, Lecture fee (Novartis, TOMEY, Nidek, HOYA, Nikon, Sanofi), Collaboration research contract, Lecture Fee (Santen), Collaboration research contract (Astellas); A. O. Tanaka, None; T. Sakai, None; M. Hashiguchi, None; M. Shimizu, None; K. Fujinami, None; S. J. Ahn, Consultant fee (Novartis); M. Kondo, Financial support (AMO, Otsuka, Kowa, Santen, Senju, Alcon, Bayer, Pfizer, HOYA, Novartis), Consultant fee (Senju, Ono); D. J. Browning received the royalties on the book entitled Hydroxychloroquine and Chloroquine Retinopathy. 2014 published by Springer; K. Shinoda, Consultant fee (Astellas), Lecture fee (Bayer, Zeiss, HOYA, IQVIA, Kowa, Mitsubishi Tanabe, Novartis, Otsuka, Santen, Senju, TOMEY), Consultant fee, Lecture fee (Leica, Sanofi), Writing assistance, Consultant fee (Nitten); N. Yokogawa, Lecture fee (AbbVie, AYUMI, Bristol Myers Squibb, Chugai, Mitsubishi Tanabe, Takeda, UCB).

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Corresponding Author: Shinji Ueno

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Ozawa, H., Ueno, S., Ohno-Tanaka, A. et al. Ocular findings in Japanese patients with hydroxychloroquine retinopathy developing within 3 years of treatment. Jpn J Ophthalmol 65, 472–481 (2021). https://doi.org/10.1007/s10384-021-00841-9

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  • DOI: https://doi.org/10.1007/s10384-021-00841-9

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