The aim of this study was to quantitatively compare the flow area of choriocapillaris layer in patients receiving from hydroxychloroquine (HCQ) therapy for more than 5 years with age and sex matched controls.


A prospective cross-sectional study.


The patients taking HCQ who were screened for toxic effects were evaluated. All patients received a complete ophthalmic examination, including measurement of best corrected visual acuity (BCVA) using a Snellen chart, biomicroscopic evaluation of anterior segment, gonioscopy, applanation tonometry and dilated fundus examination. Study participants underwent central corneal thickness (CCT) and axial length (AL) measurements using ultrasonic scans and following imaging modalities were performed: fundus photography, fundus autofluorescence (FAF), spectral domain optical coherence tomography (SD-OCT), Humphrey visual field test (VFT) and Optical coherence tomography angiography (OCTA). Inclusion criteria were patients with maximum daily HCQ use of ≤5.0 mg/kg real weight for more than five years, BCVA of at least 20/20 and no pathological findings in SD-OCT, VFT and/or FAF. Age and sex matched controls were recruited from subjects who visited our outpatient clinic and had no ocu lar and systemic diseases, no refractive spherical or cylindrical error ≥2 D, and visual acuity of 20/20 in both eyes. Flow area of choriocapillaris layer in all individuals obtained seperately at 1 mm, 2 mm and 3 mm diameter areas, centered on the foveal avascular zone (FAZ) via OCTA.


This study included 100 eyes of 50 subjects: 25 subjects in HCQ group and 25 subjects in control group. There were not significant differences between the groups in terms of age, gender distribution, CCT, AL, spherical refraction and intraocular pressure (P > 0.05 for all). The mean follow-up period was 84.50 months (range=60 – 246 months), mean daily dose 3.18 mg/kg/day and mean duration of medication exposure was 82.25 (± 50.05) months in HCQ group. The flow area of choriocapillaris layer at 1 mm, 2 mm and 3 mm diameter were 1.88 ± 0.07, 8.07 ± 0.35 and 18.01 ± 0.89 mm2 respectively in the HCQ group and 2.11 ± 0.08, 8.72 ± 0.32 and 20.06 ± 0.67 mm2 respectively in the control group and this difference show a statistically significant difference (p=0.034, p=0.042, p=0.029).


The flow area of choriocapillaris in patients with long term HCQ therapy decreases before toxicity begins and OCTA can be used as a screening tool for detecting early changes in macula.



Yasin Sakir Goker
Ulucanlar Eye Training and Research Hospital
Email : yasingoker5367@hotmail.com
Cell Phone: +905558070184
Work Phone: +903123126261