COVID-19 and Chloroquine/Hydroxychloroquine: Is There Ophthalmological Concern?

• Published in: American journal of ophthalmology Vol. 216; pp. A1 - A2
• Main Author: Marmor, Michael F.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.08.2020; Elsevier Limited
• Subjects: Antirheumatic Agents - administration & dosage; Antirheumatic Agents - toxicity; Antiviral Agents - administration & dosage; Antiviral Agents - toxicity; Betacoronavirus - drug effects; China - epidemiology; Chloroquine - administration & dosage; Chloroquine - toxicity; Clinical Trials as Topic; Coronavirus Infections - drug therapy; Coronavirus Infections - epidemiology; Coronaviruses; COVID-19; Humans; Hydroxychloroquine - administration & dosage; Hydroxychloroquine - toxicity; Lupus; Medical personnel; Pandemics; Patients; Pneumonia, Viral - drug therapy; Pneumonia, Viral - epidemiology; Retina - drug effects; Retina - pathology; Retinal Diseases - chemically induced; Retinal Diseases - diagnosis; SARS-CoV-2; China
• ISSN: 0002-9394; 1879-1891
• DOI: 10.1016/j.ajo.2020.03.029

Chloroquine (CQ) and hydroxychloroquine (HCQ) are generic antiviral agents that have shown effectiveness against severe acute respiratory syndrome (SARS) virus infection, and in this time of pandemic, physicians are trying any plausible approach to therapy.1 News reports have appeared recently about China starting trials with a variety of medications to treat coronavirus 2019 (COVID-19) infection, including both of those agents.2 In fact, at least 10 trials have started now in different countries.3 The Chinese are giving a course of CQ, 500 mg twice daily, for up to 10 days, or 400 mg of HCQ 4 times daily, and these extreme doses have raised concerns about retinal damage. None of the other patients showed damage. [...]evidence to date indicates that extreme doses do accelerate retinal toxicity but with a probable time course of many months rather than days. In a time of pandemic with worldwide shortages of medical personnel, funds, hospital beds, equipment, screening tests, and proven therapy, it would be counter-productive (and raise inappropriate fears) to suggest the addition of labor-intensive and expensive eye examinations that are of low yield.