Further Analysis on Characteristic of Diabetic Reinopathy - A Case in Thai Binh Province in Vietnam

Objective: to study the characteristics of the diabetic retinopathy and some related factors in patients with type 2 diabetes. Subject and research methods: a cross-sectional descriptive study on 80 patients with type 2 diabetes to be examined and treated at the Internal Medicine Department of Thai Binh Medical University Hospital from January to December 2019. Result: • The percentage of patients with damage to the retina accounts for 42.5%; of which, 38.8% were nonproliferative retinopathy, 17.5% were macular disease, 2.5% were pre-proliferative retinopathy and 1.2% were proliferative retinopathy. • The risk of retinal damage increased higher in women than in men; the OR coeffecient of subgroups, namely age ≥ 70 years; diabetic duration ≥ 10 years; BMI ≥ 23 (kg/m2), hypertension, was 1.4; 2.5; 4.0; 4.5; 2.5, respectively. Patients with blood glucose ≥ 7 mmol/L, HbA1c ≥ 7%; total cholesterol > 5.2 mmol/L, triglyceride > 1.88 mmol/L had higher risk of retinopathy with OR coefficient of 2.3; 2.5; 3.2; 2.0, respectively. Patients who were non-compliance with treatment had 3.8 times higher risk of retinopathy than those who complied with treatment. Conclusion: the percentage of patients with retinopathy was 42.5%, the risk of retinopathy increased in patients with one of the following characteristics: female, age ≥ 70 years, duration of diabetes ≥ 10 years, BMI ≥ 23 (kg / m2), hypertension, blood glucose concentration ≥ 7 mmol/L, HbA1c ≥ 7%; cholesterol> 5.2 mmol/L, triglyceride> 1.88 mmol/L.

OP0133 THE PREVALENCE AND RISK FACTORS OF RETINAL TOXICITY ASSOCIATED WITH LONG-TERM HYDROXYCHLOROQUINE USE

Background:Hydroxychloroquine (HCQ) is commonly used for the treatment of various autoimmune diseases. The medication is generally well-tolerated. However, long-term use after 5 years may increase the risk of retinopathy. One study in 2014 has demonstrated the risk can be as high as 7.5%. Optical Coherence Tomography (OCT) has become a major modality in screening retinopathy.Objectives:To evaluate the prevalence of retinal toxicity among patients using hydroxychloroquine and to determine various risk factors associated with hydroxychloroquine-associated retinal toxicity.Methods:We performed a retrospective chart review on a cohort of adult patients with long-term use (≥ 5 years cumulative) of HCQ between January 1st, 2011 to December 31st, 2018 from the Kaiser Permanente San Bernardino County and Riverside medical center areas in Southern California, USA. Patients were excluded if they had previously been diagnosed with retinopathy prior to hydroxychloroquine use, were deceased, or had incomplete OCT exam. Our primary endpoint was the prevalence of patients who developed retinal toxicity detected by OCT, and later confirmed by retinal specialist. Potential risk factors (age, duration of therapy, daily consumption per actual body weight, cumulative dose, confounding diseases and medication) for developing retinopathy were also evaluated. Univariable and multivariable logistic regression analyses were used to determine risk factors associated with retinal toxicity.Results:Among 676 patients exposed to more than 5 years of HCQ, the overall prevalence of retinal toxicity was 6.8%, and ranged from 2.5% to 22.2% depending on the age, weight-based dosing, duration of use and cumulative dose. Duration of therapy for 10 years or more increased risk of retinopathy by approximately 5 to 19 folds. Similarly, weight-based dose of 7 mg/kg/day or greater was assciated with increased risk of retinopathy by approximately 5 times. Patients with cumulative dose of 2000 grams or more had greater than 15 times higher risk of developing retinopathy. Duration of use for10 years or more (odd ratio 4.32, 95% CI 1.99 – 12.49), age (odd ratio 1.04; 95% CI 1.01 - 1.08), cumulative dose of more than 1500 g (odd ratio 7.4; 95% CI 1.40 – 39.04) and atherosclerosis of the aorta (odd ratio 2.59; 95% CI, 1.24 – 5.41) correlated with higher risk of retinal toxicity.Conclusion:The overall prevalence of retinopathy was 6.8%. Regular OCT screening, especially in patients with hydroxychloroquine use for more than 10 years, daily intake > 7 mg/kg, or cumulative dose > 1500 grams is important in detecting hydroxychloroquine-associated retinal toxicityReferences:[1]Hobbs HE. Sorsby A, & Freedman A. Retinopathy Following Chloroquine Therapy. The Lancet. 1959; 2(7101): 478-480.[2]Levy, G. D., Munz, S. J., Paschal, J., Cohen, H. B., Pince, K. J., & Peterson, T. Incidence of hydroxychloroquine retinopathy in 1,207 patients in a large multicenter outpatient practice. Arthritis & Rheumatism: 1997; 40(8): 1482-1486.[3]Ding, H. J., Denniston, A. K., Rao, V. K., & Gordon, C. Hydroxychloroquine-related retinal toxicity. Rheumatology. 2016; 55(6): 957-967.[4]Stelton, C. R., Connors, D. B., Walia, S. S., & Walia, H. S. Hydrochloroquine retinopathy: characteristic presentation with review of screening. Clinical rheumatology. 2013; 32(6): 895-898.[5]Marmor, M. F., Kellner, U., Lai, T. Y., Melles, R. B., & Mieler, W. F. Recommendations on screening for chloroquine and hydroxychloroquine retinopathy (2016 revision). Ophthalmology. 2016; 123(6): 1386-1394.[6]Melles, R. B., & Marmor, M. F. The risk of toxic retinopathy in patients on long-term hydroxychloroquine therapy. JAMA ophthalmology. 2014; 132(12): 1453-1460.Disclosure of Interests:None declared

POS1397 HYDROXYCHLOROQUINE INDUCED RETINAL TOXICITY IN PATIENTS WITH RHEUMATIC DISEASES

Background:Retinal toxicity from hydroxychloroquine (HCQ) is rare, but the vision loss maybe irreversible and could have medicolegal consequences.Objectives:To determine the prevalence and assess the predictors of retinal toxicity due to HCQ in patients with rheumatic diseases. There is paucity of literature on retinal toxicity due to HCQ in rheumatic diseases.Methods:A retrospective observational study was conducted in the Department of Clinical Immnuology and Rheumatology, Sri Ramachandra Institute of Higher Education and Research,Chennai, India from November 2018-May 2020, on patients taking HCQ for more than 6 months. All patients underwent ophthalmological screening at baseline and every 6 months, and thereafter by modern day screening methods-Humphrey Visual Field (HVF)10-2, Spectral Domain Optical Coherence Tomography(SD-OCT), except for patients with evidence of suspected retinal toxicity at baseline.Fundus autofluorescence (FAF) was done in feasible patients.Results:9 out of 743(1.2%) patients were identified to have retinal toxicity, detected via fundus examination (n=9), SD-OCT (n=8/9), HVF 10-2 (n=6/9), FAF (n=1/9). 55.5% (n=5/9) had Rheumatoid Arthritis(RA) and 44.4% (n=4/9) had Systemic Lupus Erythematosus(SLE) as their primary diagnosis. 77.7% (n=7/9) were females. The mean age was 47.5 years (20-72 years).75%(n=3/4) of SLE patients were below 30 years of age. The average daily and cumulative dose of HCQ in these 9 patients were 244 mg (200-400mg) and 311.22g(73-730g)respectively, whereas the mean recommended dose as per real body weight was 287.2mg/day. Average duration of HCQ consumption was 3.6 years (1-10 years).Only 11.1% (n=1/9) had presented with visual complaints of black floaters.Conclusion:The asymptomatic nature of this irreversible toxicity, warrants frequent screening.Retinal toxicity was not age-related.Toxicity was manifested at low daily and cumulative doses.Screening should be done atleast every 6 months by fundus examination.Objective tests like HVF and SD-OCT should be done annually, especially in patients with underlying rheumatic diseases.The early manifestation of retinal toxicity in young SLE patients could have a genetic association and needs further evaluation.References:[1]Mortada A Abozaid et al. hydoxychloroquine retinopathy in a ohort of patients from upper Egypt.Journal of Egyptioan Ophthalmological Society 2017;110:110-113[2]Roy AN,Samala V,Kumar YA,Fatima SS.Assessing the risk of retinopathy in Indian patients using hydroxychloroquine for rheumatic and musculoskeletal Diseases:A Retrospective Observational Study.Indian J Rheumatol 2020.Disclosure of Interests:None declared