The effect of long-term hydroxychloroquine use on the corneal endothelium in patients with systemic lupus erythematosus
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ORIGINAL PAPER
The effect of long-term hydroxychloroquine use on the corneal endothelium in patients with systemic lupus erythematosus Esra Vural
. Leyla Hazar
. Kemal Erol
Received: 10 April 2020 / Accepted: 29 October 2020 Ó Springer Nature B.V. 2020
Abstract Purpose To evaluate the effect of long-term effects of hydroxychloroquine (HCQ) use on the corneal endothelium in patients with systemic lupus erythematosus (SLE). Methods The study included 30 eyes of 15 patients who used HCQ for at least five years and were followed up in the rheumatology clinic for SLE and 29 eyes of 15 patients newly diagnosed with SLE who had not taken any medication. All patients underwent complete ophthalmologic examinations, central corneal thickness measurements, endothelial cell counts and endothelial morphological examinations by specular microscopy. Results The mean age was 41.25 ± 6.89 years in group 1 and 41.81 ± 5.78 years in group 2 (p = 0.737). The mean corneal endothelial cell density was 2662 ± 184 cells/mm2 in group 1 and 2649 ± 315 cells/mm2 in group 2 (p = 0.843). The
percentage of cell hexagonality was 46.6 ± 11.8% in group 1 and 48.7 ± 13.8% in group 2 (p = 0.625). A difference was noted in endothelial cell variation in both groups, at 36.7 ± 6.9% in group 1 and 39.9 ± 6.2% in group 2 (p = 0.057) but not statistically significant. No difference was observed between the two groups in terms of central corneal thickness. The duration of HCQ use was negatively correlated with hexagonality (r = -0.564, p = 0.001) Conclusion Long-term use of HCQ in SLE patients had no negative effect on endothelial cell density and cell variation, but a negative correlation existed between the duration of HCQ usage and hexagonality. Keywords Corneal endothelium Drug Hydroxychloroquine Systemic lupus erythematosus
Introduction E. Vural (&) Department of Ophthalmology, Kayseri City Hospital, 38010 Kocasinan, Kayseri, Turkey e-mail: [email protected] L. Hazar Department of Ophthalmology, Mardin Kızıltepe State Hospital, Mardin, Turkey K. Erol Department of Rheumatology, Kayseri City Hospital, Kayseri, Turkey
Systemic lupus erythematosus (SLE) is a complex connective tissue disease that affects multiple organ systems. In the eye, the symptoms of SLE vary and are affected by systemic disease activity [1, 2]. Ocular involvement is most commonly seen as keratoconjunctivitis sicca, while retinal and choroid involvement may cause loss of vision [3–5]. Filamentous keratitis and ulcers secondary to keratoconjunctivitis sicca may develop [6, 7]. Rarely, peripheral ulcerative
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keratitis, interstitial keratitis and endotheliitis (dysfunctional appearing corneal endothelial cells) were reported in patients with SLE [8, 9]. It has also been reported that SLE may cause changes in the biomechanical properties of the cornea [10]. One cornerstone of SLE management is the drug hydroxychloroquine (HCQ), which is known to reduce the risk of disease activity, morbidity and end-or
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