Mise à jour des recommandations sur la toxicité rétinienne des antipaludéens de synthèse

The risk of developing CQ or HCQ retinopathy depends on the daily dose and duration of treatment. At recommended doses, the risk is < 1 % at 5 years, < 2 % at 10 years but increases to about 20 % after 20 years of treatment. The maximum recommended daily dose is 5.0 mg/kg for HCQ and 2.3 mg/kg for CQ. The two main risk factors are the daily dose and duration of treatment. The presence of kidney failure and treatment with tamoxifen are also significant risk factors. A baseline examination should be performed at the initiation of treatment to rule out pre-existing maculopathy. The screening is then annual and starts from the 5th year of treatment. The two tests recommended for screening are the automated visual field and spectral domain OCT. Multifocal ERG and autofluorescence fundus imaging are only carried out secondarily to confirm the pathology.