Optical coherence tomography angiography parameters in patients on hydroxychloroquine therapy

Document Type

Article

Publication Date

2026

Abstract

Purpose

To evaluate subclinical retinal microvascular changes in long-term hydroxychloroquine (HCQ) users (≥ 5 years) using optical coherence tomography angiography (OCTA), comparing retinal parameters with a healthy control group.

Method

This single-center, case–control study involved 118 participants (comprising of 59 HCQ users and 59 controls) who underwent comprehensive ophthalmic evaluations, including OCTA to assess the foveal avascular zone (FAZ), macular vessel density (VD) in superficial and deep capillary plexus (SCP and DCP), and retinal thickness. Statistical tests included independent t, Mann–Whitney U, and Spearman’s rank correlation tests, with significance set at p <  0.05.

Results

Most HCQ users were female (88.14%) with a median age of 47 years, primarily treated for systemic lupus erythematosus (SLE), receiving a mean HCQ dose of 5.14 mg/kg/day. FAZ area and central foveal thickness (CFT) did not differ significantly between groups. However, parafoveal and perifoveal retinal thickness was significantly reduced in the HCQ group (p <  0.001). Macular VD was significantly higher in the foveal and parafoveal DCP among HCQ users (p <  0.001).

Conclusion

Long-term HCQ use is associated with significant parafoveal and perifoveal retinal thinning, with variable OCTA microvascular changes. These findings highlight the potential role of OCTA in early detection of HCQ-induced retinal alterations.

Keywords

Foveal avascular zone, Hydroxychloroquine, Optical coherence tomography, Optical coherence tomography angiography, Vessel density

Publication Title

International Ophthalmology

ISSN

0165-5701

DOI

10.1007/s10792-025-03911-w

Volume

46

Issue

1

First Page

59

Publisher

Springer

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