Ocular safety of hydroxychloroquine when used as prophylaxis against COVID-19 in healthcare workers at a tertiary care center in India

Divya D Sundaresh; Soumya Ramani; Rachana Kotian

Divya D Sundaresh, Soumya Ramani, M S Ramaiah Rachana Kotian

Ophthalmology Journal, doi:10.5603/oj.93780

BACKGROUND: The aim was to correlate hydroxychloroquine's dose and duration and its effect on colour vision, contrast sensitivity, retinal nerve fiber layer (RNFL) and macula assessed by optical coherence tomography (OCT) and to comment on the ocular effects of a short-term high-dose course of hydroxychloroquine in healthcare workers. A cross-sectional observational study was done in a large 650-bed tertiary centre managing around 2500 COVID-19 patients. The healthcare workers rendering the care were administered hydroxychloroquine optionally as a prophylaxis against Sars-Cov-2 infection. The healthcare workers who used hydroxychloroquine prophylaxis were enrolled in this study. The dose and duration of hydroxychloroquine were noted. MATERIAL AND METHODS: Ethical clearance was sought and the enrolled individuals underwent a detailed ophthalmic examination. The OCT of RNFL thickness with ganglion cell layer (GCL) and OCT macula was assessed. The dose of hydroxychloroquine received and its effects on colour vision, contrast sensitivity, OCT RNFL thickness, and OCT macula were correlated. Statistical analysis was performed with SPSS software for Windows, version 18. The correlation between the exposure time, cumulative dose, and SD-OCT parameters was evaluated using Pearson's correlation coefficient. p-values < 0.05 were considered statistically significant. RESULTS: Average macular thickness and RNFL thickness in all quadrants did not significantly correlate (p > 0.001) with a cumulative dose of hydroxychloroquine and the duration of hydroxychloroquine use. CONCLUSIONS: Our study concludes that no ocular adverse effects are noted with the high-dose short-term use of hydroxychloroquine for COVID-19 prophylaxis in contrast to the long-term use of hydroxychloroquine for several systemic conditions.

Conflict of interests Authors declare no conflict of interest.

References

Lane, Weaver, Kostka, OHDSI-COVID-19 consortium. Risk of hydroxychloroquine alone and in combination with azithromycin in the treatment of rheumatoid arthritis: a multinational, retrospective study, Lancet Rheumatol, doi:10.1016/S2665-9913(20)30276-9

Lee, Kim, Ham, Macular retinal ganglion cell-inner plexiform layer thickness in patients on hydroxychloroquine therapy, Invest Ophthalmol Vis Sci, doi:10.1167/iovs.14-15138

Mavrikakis, Sfikakis, Mavrikakis, The incidence of irreversible retinal toxicity in patients treated with hydroxychloroquine: a reappraisal, Ophthalmology, doi:10.1016/S0161-6420(03)00409-3

Melles, Marmor, The risk of toxic retinopathy in patients on long-term hydroxychloroquine therapy, JAMA Ophthalmol, doi:10.1001/jamaophthalmol.2014.3459

Monti, Vertogen, Masini, Hydroxychloroquine as Prophylaxis for COVID-19: A Review, Front Pharmacol, doi:10.3389/fphar.2020.605185

Murray, Lee, Marmor, American Academy of Ophthalmology, American Academy of Ophthalmology. Revised recommendations on screening for chloroquine and hydroxychloroquine retinopathy, Ophthalmology, doi:10.1016/j.ophtha.2010.11.017

Nicolò, Desideri, Bassetti, Hydroxychloroquine and chloroquine retinal safety concerns during COVID-19 outbreak, Int Ophthalmol, doi:10.1007/s10792-020-01593-0

Pasadhika, Fishman, Choi, Effects of chronic exposure to hydroxychloroquine or chloroquine on inner retinal structures, Eye (Lond), doi:10.1038/eye.2009.65

Pasaoglu, Onmez, Macular toxicity after short-term hydroxychloroquine therapy, Indian J Ophthalmol, doi:10.4103/ijo.IJO_732_18

Rodriguez-Padilla, Hedges, Monson, High-speed ultra-high-resolution optical coherence tomography findings in hydroxychloroquine retinopathy, Arch Ophthalmol, doi:10.1001/archopht.125.6.775

Rosenthal, Kolb, Bergsma, Chloroquine retinopathy in the rhesus monkey, Invest Ophthalmol Vis Sci

Ruamviboonsuk, Lai, Chang, for Asia-Pacific Vitreo-Retina Society. Chloroquine and Hydroxychloroquine Retinal Toxicity Consideration in the Treatment of COVID-19, Asia Pac J Ophthalmol, doi:10.1097/APO.0000000000000289

Shukla, Shukla, Expanding horizons for clinical applications of chloroquine, hydroxychloroquine, and related structural analogues, Drugs Context, doi:10.7573/dic.2019-9-1

Vincent, Bergeron, Benjannet, Chloroquine is a potent inhibitor of SARS coronavirus infection and spread, Virol J, doi:10.1186/1743-422X-2-69

Wu, Du, Lin, Retinal nerve fibre layer thickness measured with SD-OCT in a population-based study: the Handan Eye Study, Br J Ophthalmol, doi:10.1136/bjophthalmol-2021-320618

DOI record: { "DOI": "10.5603/oj.93780", "ISSN": [ "2450-9930" ], "URL": "http://dx.doi.org/10.5603/oj.93780", "author": [ { "affiliation": [], "family": "Sundaresh", "given": "Divya D", "sequence": "first" }, { "affiliation": [], "family": "Ramani", "given": "Soumya", "sequence": "additional" }, { "affiliation": [], "family": "Kotian", "given": "Rachana", "sequence": "additional" } ], "container-title": "Ophthalmology Journal", "container-title-short": "Ophthalmol J", "content-domain": { "crossmark-restriction": false, "domain": [] }, "created": { "date-parts": [ [ 2024, 11, 5 ] ], "date-time": "2024-11-05T14:05:58Z", "timestamp": 1730815558000 }, "deposited": { "date-parts": [ [ 2024, 11, 5 ] ], "date-time": "2024-11-05T14:05:58Z", "timestamp": 1730815558000 }, "indexed": { "date-parts": [ [ 2024, 11, 6 ] ], "date-time": "2024-11-06T05:27:43Z", "timestamp": 1730870863991, "version": "3.28.0" }, "is-referenced-by-count": 0, "issue": "0", "issued": { "date-parts": [ [ 2024, 1, 19 ] ] }, "journal-issue": { "issue": "0", "published-online": { "date-parts": [ [ 2024, 1, 19 ] ] } }, "link": [ { "URL": "https://journals.viamedica.pl/ophthalmology_journal/article/viewFile/93780/80148", "content-type": "unspecified", "content-version": "vor", "intended-application": "similarity-checking" } ], "member": "3595", "original-title": [], "page": "155-161", "prefix": "10.5603", "published": { "date-parts": [ [ 2024, 1, 19 ] ] }, "published-online": { "date-parts": [ [ 2024, 1, 19 ] ] }, "publisher": "VM Media Group sp. z o.o", "reference-count": 0, "references-count": 0, "relation": {}, "resource": { "primary": { "URL": "https://journals.viamedica.pl/ophthalmology_journal/article/view/93780" } }, "score": 1, "short-title": [], "source": "Crossref", "subject": [], "subtitle": [], "title": "Ocular safety of hydroxychloroquine when used as prophylaxis against COVID-19 in healthcare workers at a tertiary care center in India", "type": "journal-article", "volume": "9" }