Impact of Structural Changes on Multifocal Electroretinography in Patients With Use of Hydroxychloroquine

Borrelli, Enrico; Battista, Marco; Cascavilla, Maria Lucia; Viganò, Chiara; Borghesan, Federico; Nicolini, Nicolò; Clemente, Lidia; Sacconi, Riccardo; Barresi, Costanza; Marchese, Alessandro; Miserocchi, Elisabetta; Modorati, Giulio; Bandello, Francesco; Querques, Giuseppe

doi:10.1167/iovs.62.12.28

Cited by 7 publications

(9 citation statements)

References 39 publications

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“…In addition, increased qAF 8 values were not related to EZ/IZ thinning since all patients with detectable outer retinal layers alterations were excluded from the analysis. 26,27 These results are similar to those reported by Reichel et al 23 in a recent study where they evaluated the qAF in 29 patients taking HCQ with and without BEM. However, Reichel and colleagues used a specifically designed method for their measurements named qAF 97.…”

Section: Discussionsupporting

confidence: 87%

“…Interestingly, we also found that qAF 8 values were on average higher in HCQ patients than in untreated subjects, although this difference did not reach statistical significance. In addition, increased qAF 8 values were not related to EZ/IZ thinning since all patients with detectable outer retinal layers alterations were excluded from the analysis 26,27 . These results are similar to those reported by Reichel et al 23 in a recent study where they evaluated the qAF in 29 patients taking HCQ with and without BEM.…”

Section: Discussionsupporting

confidence: 84%

“…Infact, subtle parafoveal abnormalities of outer retinal layers as well as inner and outer nuclear layers have been described as early OCT signs of retinal toxicity. 26,27 More importantly, once anatomical alterations become detectable by OCT or SW-AF they are already irreversible and can even keep worsening after drug suspension. 4 Identifying HCQ toxicity at a preclinical stage would hence be ideal to prevent permanent vision loss.…”

Section: Discussionmentioning

confidence: 99%

“…There is still poor comprehension of preclinical retinal events associated with HCQ intake although early recognition of HCQ retino‐toxicity has improved in the last decade. Infact, subtle parafoveal abnormalities of outer retinal layers as well as inner and outer nuclear layers have been described as early OCT signs of retinal toxicity 26,27 . More importantly, once anatomical alterations become detectable by OCT or SW‐AF they are already irreversible and can even keep worsening after drug suspension 4 .…”

Section: Discussionmentioning

confidence: 99%

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Quantitative autofluorescence findings in patients undergoing hydroxychloroquine treatment

Parrulli

Cozzi

Airaldi

et al. 2022

Clinical Exper Ophthalmology

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Background: To measure quantitative autofluorescence (qAF) in patients under treatment with hydroxychloroquine (HCQ) and at risk of retinal toxicity but with no apparent signs of retinal toxicity and to compare it with that of untreated subjects.Methods: Consecutive patients at risk for the development of HCQ retinal toxicity (duration of treatment >5 years or daily HCQ dose >5 mg/kg of actual body weight [ABW]) but no alterations on spectral domain-optical coherence tomography, short-wavelength autofluorescence and 10-2 visual field examination were recruited. Healthy subjects matched by age and sex were also enrolled in the study. All subjects underwent qAF measurements in one eye.Images were analysed using the conventional qAF grid by Delori calculating the qAF of eight sectors of the intermediate ring and the mean of those values (qAF 8 ).Results: Thirty-nine patients treated with HCQ (38 females, mean age 52.1 ± 8.6 years) and 39 untreated subjects (38 females, mean age 51.2 ± 8.6 years) were included. In both HCQ patients and untreated subjects, qAF 8 was positively correlated with age (p = 0.004). Although HCQ patients showed a higher mean qAF 8 compared with untreated subjects (294.7 ± 65.3 vs. 268.9 ± 57.5), the difference was not significant (p = 0.068). HCQ patients showed significantly higher mean qAF values in the inferior-temporal, inferior and inferior-nasal sectors of the intermediate ring of qAF grid compared with untreated subjects (all p < 0.05).Conclusions: These results suggest a possible preclinical increase of qAF values in inferior parafoveal sectors probably induced by HCQ exposure.Mariano Cozzi shared first authorship.

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Section: Discussionsupporting

confidence: 87%

Section: Discussionsupporting

confidence: 84%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Quantitative autofluorescence findings in patients undergoing hydroxychloroquine treatment

Parrulli

Cozzi

Airaldi

et al. 2022

Clinical Exper Ophthalmology

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“…Moreover, multifocal electroretinography (mfERG) results were available only for a few patients. Because mfERG can be used to topographically correlate functional defects with structural findings 25 , this should be evaluated in future studies as it may be valuable for understanding structure–function relationship in hydroxychloroquine retinopathy and also for the early detection of hydroxychloroquine retinopathy.…”

Section: Discussionmentioning

confidence: 99%

Clock-hour topography and extent of outer retinal damage in hydroxychloroquine retinopathy

Kim

et al. 2022

Sci Rep

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In this study, we investigated the clock-hour topographic characteristics and extent of photoreceptor and retinal pigment epithelium (RPE) damage and correlated the extent with functional defects in eyes with hydroxychloroquine retinopathy. A total of 146 eyes of 75 patients diagnosed with hydroxychloroquine retinopathy were included. The clock-hour topographic characteristics (relative to the fovea) and extent of the photoreceptor and RPE defects in the parafoveal and pericentral areas were evaluated by reviewing the radial-scan optical coherence tomography (OCT) and wide-field fundus autofluorescence (FAF) images. The extent of outer retinal damage in the parafoveal and pericentral areas were correlated with the perimetric parameters of the Humphrey 10–2 and 30–2 tests, respectively. Although the photoreceptor damage was most commonly noted at the temporal to inferior locations in both parafoveal and pericentral areas, the RPE damage in the pericentral eyes was most commonly noted in the nasal area and showed topographic discrepancies with photoreceptor damage. The extent of RPE damage was almost identical between OCT and FAF images, whereas photoreceptor defect extent was significantly greater on OCT images. The extent of parafoveal and pericentral photoreceptor damage on OCT images was significantly correlated with perimetric parameters of the 10–2 and 30–2 tests, respectively (all P < 0.05). Our findings on the detailed topographic characteristics using a clock-hour-based system and significant correlation between the structural extent and perimetric parameters suggest that this evaluation may facilitate more comprehensive descriptions of structural damage extent and predictions of visual function.

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Decreased peri-parafoveal RPE, EZ and ELM intensity: A novel predictive biomarker for hydroxychloroquine retinal toxicity

Yucel Gencoglu,

Ağın,

Colak

et al. 2024

Graefes Arch Clin Exp Ophthalmol

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Purpose To evaluate the reflectivities of the retinal pigment epithelium (RPE), ellipsoid zone (EZ), and external limiting membrane (ELM) in the central fovea, perifoveal, and parafoveal regions with Optical Coherence Tomography (OCT) and the change in choroid vascular index (CVI) in patients using hydroxychloroquine (HCQ). Methods Sixty-one patients underwent HCQ treatment; age and sex-matched 44 control group subjects were included in the study. The RPE, EZ, and ELM reflectivities were measured with the ImageJ program at 5 points, and CVI was calculated. Results RPE, EZ, and ELM reflectivities in the central fovea were higher in the HCQ group than in the control group (p < 0.001, p = 0.013, p = 0.022). In the HCQ group, there was a decrease in RPE reflectivities in the temporal, nasal parafovea, and nasal perifovea (p = 0.001, p = 0.03, p = < 0.001). EZ and ELM reflectivity in the nasal parafovea and nasal perifovea was lower in the patient group than in the control group (p = 0.007, p = 0.005, p = 0.009, p = 0.001). In the HCQ group, all absolute para and perifoveal reflectivities relative to the fovea decreased significantly more than in the control group (p < 0.05). Conclusion In patients who underwent HCQ treatment, there is a decrease in the reflectivities of the para and perifoveal RPE, EZ, and ELM compared to the fovea. This decrease is more pronounced than the decrease in reflectivity in the para and perifoveal regions compared to the fovea in people who do not use HCQ. This situation can be considered as a sign of toxicity that is a precursor to overt maculopathy.

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Impact of Structural Changes on Multifocal Electroretinography in Patients With Use of Hydroxychloroquine

Cited by 7 publications

References 39 publications

Quantitative autofluorescence findings in patients undergoing hydroxychloroquine treatment

Quantitative autofluorescence findings in patients undergoing hydroxychloroquine treatment

Clock-hour topography and extent of outer retinal damage in hydroxychloroquine retinopathy

Decreased peri-parafoveal RPE, EZ and ELM intensity: A novel predictive biomarker for hydroxychloroquine retinal toxicity

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