Progression of hydroxychloroquine-induced retinopathy after drug cessation.
Level 4 - case-series / case-control
Retrospective multicenter case series without a control group.
PubMed 41504875 · doi:10.1007/s00417-025-07037-8
What was done
A multicenter retrospective observational case series analyzed 25 retinal lesions across 18 eyes of 11 female patients with hydroxychloroquine (HCQ) retinopathy treated at Zurich University Hospital and Tel Aviv Sourasky Medical Center between 2012 and 2020. Structural damage (ellipsoid zone defects and photoreceptor alterations) was measured on spectral-domain optical coherence tomography (SD-OCT) at initial diagnosis and at follow-up visits ranging from 2 months to 5.5 years after HCQ cessation.
What was found
The cohort had an average age of 53.0 years, an average daily HCQ dose of 310 mg, and an average treatment duration of 15.6 years (54.5% systemic lupus erythematosus, 54.5% non-Ashkenazi Caucasian, 18.2% Ashkenazi). After drug cessation, absolute increases in lesion size ranged from 7 to 552 μm (median change 99 μm), with an average lesion progression rate of 131.6 μm/year across all included eyes.
Why it matters
The findings demonstrate that structural retinal damage from HCQ toxicity can continue to expand after drug discontinuation. This underscores the need for early screening detection before damage progresses toward the central fovea.
Limits
The sample size is very small (11 patients, 18 eyes) and entirely female. The retrospective case-series design lacks a control group, follow-up intervals varied substantially (2 months to 5.5 years), and functional visual measures were not reported in the abstract.
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- supports Hydroxychloroquine can cause cardiac rhythm disorders as well as permanent, irreversible visual changes.