Children exposed to hydroxychloroquine in utero show no signs of retinal toxicity at age 5.

OBJECTIVE

Limited examinations from prior studies support the absence of retinal toxicity in infants exposed to maternal hydroxychloroquine (HCQ). However, the infant retina does not have adult morphology that could show typical signs of HCQ retinopathy. Using the Preventive Approach To Congenital Heart Block with Hydroxychloroquine (PATCH) study, children at age 5 (when adult morphology has been reached) were evaluated using modern imaging techniques.

METHODS

Ocular coherence tomography (OCT) was performed (CIRRUS HD-OCT, Carl Zeiss Meditec) at age 5 on 10 PATCH children exposed to maternal HCQ 400 mg daily and 16 healthy controls unexposed to HCQ matched for gestational age at birth, sex and race/ethnicity. Cross-sectional images were examined by a retinal specialist blinded to exposure history. OCT retinal thickness values were displayed in the 9 Early Treatment Diabetic Retinopathy Study (ETDRS) regions by CIRRUS software and compared with available normative data.

RESULTS

Cord blood levels substantiated HCQ exposure. OCT cross sections were normal with no visible thinning diffusely or focally in the ganglion cell layer, photoreceptors, ellipsoid zone or retinal pigment epithelium. ETDRS regional thickness values were less reliable because of poor resolution with some OCT recordings but showed overall thickness (in micrometres) averaging 297.70±10.53 in controls compared with 288.92±13.77 for those in PATCH, p=0.18. Both values fell within normative data for healthy children.

CONCLUSIONS

Cross-sectional OCT anatomy in HCQ-exposed children was normal at age 5 with no evidence of toxicity, providing further reassurance that HCQ use during pregnancy does not result in retinal toxicity in the offspring.