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Evaluation of risk factors for retinal damage due to chloroquine and hydroxychloroquine
  1. R Bergholz,
  2. J Schroeter,
  3. K Rüther
  1. Department of Ophthalmology, Charité Universitätsmedizin Berlin, Campus Virchow-Klinikum
  1. Correspondence to Dr R Bergholz, Charité Universitätsmedizin Berlin, Augenklinik Campus Virchow-Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany; richard.bergholz{at}


Background/Aims To evaluate risk factors for retinal damage due to the intake of chloroquine and hydroxychloroquine.

Methods In a retrospective chart review, patients receiving or having received one of the drugs were classified as affected by maculopathy or retinopathy, or as not affected on the basis of the documented findings. Uncertain cases were excluded. The risk factors as postulated by the American Academy of Ophthalmology (AAO) and additional factors like diagnosis of underlying disease, total dose, nicotine abuse and the sum of the AAO risk factors were compared between both groups.

Results 51 patients with a history of or ongoing treatment with chloroquine (23 individuals) or hydroxychloroquine (28 individuals) were included. Most of the postulated risk factors were expectedly elevated in the affected group. Significant differences applied to age, duration of intake and the sum of AAO risk factors. Surprisingly, positive smoking history was more frequent in the not affected. The toxic threshold of the daily chloroquine dose was exceeded by most of the patients.

Conclusions Age and the duration of intake are major risk factors. Smoking seems to be negligible. The sum of AAO risk factors can give an estimation of the individual risk profile. Individual and weight-adapted dosing is especially essential for chloroquine.

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  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.