Application of Optical Coherence Tomography Angiography for hydroxychloroquine-induced microvascular changes: a systematic review and meta-analysis

Abstract Background Retinal toxicity with long-term hydroxychloroquine (HCQ) treatment is a major concern. This systematic review aims to assess the application of Optical Coherence Tomography Angiography (OCTA) to detect HCQ-induced microvascular alterations. Methods PubMed, Scopus, Web of Science, and Cochrane Library databases were systematically searched until November 1st, 2021. Studies using OCTA as a primary diagnostic method to evaluate the macular microvasculature of HCQ users were included. Primary outcomes were macular vessel density (VD) and foveal avascular zone (FAZ) at the superficial (SCP) and deep (DCP) capillary plexus. Meta-analysis was performed using a random-effects model. Results Of 159 screened abstracts, seven were found eligible, enrolling 424 eyes from 335 patients. High-risk patients due to longer duration of treatment presented lower VD in the retinal microvasculature than those with low-risk in SCP (P = 0.01 in fovea; P = 0.002 in parafovea) and in DCP (P = 0.03 in fovea). When compared with healthy controls, HCQ users had lower VD in both plexus and a wider FAZ area – no quantitative synthesis was presented. Conclusions Microvascular changes were found in autoimmune patients under HCQ treatment without any documented retinopathy. However, the evidence produced so far does not allow to draw conclusion concerning the effect of drug as studies were not controlled for disease duration.