Rapid Macular Thinning Is an Early Indicator of Hydroxychloroquine Retinal Toxicity

Melles, Ronald B.; Marmor, Michael F.

doi:10.1016/j.ophtha.2022.05.002

Cited by 15 publications

(16 citation statements)

References 26 publications

(20 reference statements)

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“…In patients with long HCQ therapy duration, we demonstrated a reduced whole-en-face RT compared to the control group. Latest publications of Kim et al and Marmor et al emphasize the sensitivity of RT analysis in detecting HCQ retinopathy [ 22 – 24 ]. Marmor et al even suggest that sequential RT analysis might be the earliest diagnostic sign of HCQ retinopathy [ 24 ].…”

Section: Discussionmentioning

confidence: 99%

Retinal microvascular density analysis in patients with rheumatoid arthritis treated with hydroxychloroquine

Eßer¹,

Zimmermann²,

Storp³

et al. 2022

Graefes Arch Clin Exp Ophthalmol

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Purpose Rheumatoid arthritis (RA) is the most common inflammatory joint disease, and hydroxychloroquine (HCQ) is an established treatment. The extent to which HCQ impacts ocular microvascular vessel density (VD) in patients with RA without evidence of HCQ retinopathy has not yet been conclusively clarified. The main aim of this study was to evaluate VD measured by optical coherence tomography angiography (OCTA) in patients with RA treated with HCQ. Methods The VD data of the 3 × 3 mm OCT angiogram (RTVue XR Avanti, Optovue Inc., Fremont, California, USA) as well as the retinal thickness (RT) data of patients with RA (n = 30) and healthy controls (n = 30) were extracted and analyzed. The study group was further divided into patients undergoing HCQ treatment for > 5 years (high-risk-group) and < 5 years (low-risk group). Results Patients with RA showed no evidence of VD reduction compared to the control group in all obtained regions (p > 0.05). Correlation analysis revealed no dependency between VD, RT, and HCQ therapy duration or cumulative HCQ dose (p > 0.05). High-risk patients showed a decreased VD in the superficial quadrant of the superficial capillary plexus compared to low-risk-patients (p = 0.022). Whole-en-face RT was reduced in the high-risk group compared to the control group (p = 0.019). Conclusion Our study showed no evidence that HCQ diminishes VD in patients with RA without HCQ retinopathy measured by OCTA. However, RA patients with a long duration of therapy showed a significantly reduced RT. Our results suggest that quantitative VD analysis by OCTA may not be suitable for early detection of HCQ retinopathy and that the focus on detecting early HCQ retinopathy should be on intensive and sequential OCT diagnostics.

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Section: Discussionmentioning

confidence: 99%

Retinal microvascular density analysis in patients with rheumatoid arthritis treated with hydroxychloroquine

Eßer¹,

Zimmermann²,

Storp³

et al. 2022

Graefes Arch Clin Exp Ophthalmol

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“…Outer nuclear thinning without overt qualitative photoreceptor defects, which have been suggested as an early change in hydroxychloroquine retinopathy ( 17 ), is usually difficult to discern based on the examination of raw OCT B-scans, even by retinal specialists. However, methods of automated image analysis or longitudinal comparisons of sequential OCT images may assist in the identification of more subtle signs of toxic retinopathy ( 11 , 20 ).…”

Section: Conventional Imaging Used For Screening Hydroxychloroquine R...mentioning

confidence: 99%

“…The rapid decrease in retinal thickness preceded the appearance of any obvious qualitative morphologic changes on OCT B-scans; therefore, clinicians might identify drug-induced retinal toxicity early using these techniques ( 24 ). A recent study showed that 38 of 82 patients with rapid retinal thinning eventually developed conventional OCT or visual field signs of retinal toxicity ( 20 ). Accordingly, if validated, this characteristic pattern in the early natural history of retinal toxicity may be used to detect retinopathy at an earlier stage (e.g., 4–5 years before clinical diagnosis) than is possible with standard OCT image analysis ( 24 ).…”

Section: Advanced Optical Coherence Tomography-based Analysismentioning

confidence: 99%

“…In the future, a greater understanding of the early natural history of hydroxychloroquine retinopathy as revealed by retinal imaging techniques is likely to enable the earlier detection of disease. For example, the identification of sequential retinal thinning within the macula in some patients who were subsequently diagnosed with retinopathy by conventional definitions ( 20 ) illustrates how basic image analysis may further inform risk of toxicity, beyond the inspection of a single OCT B-scan by a trained human observer. The widespread availability of analysis of segmented images may further refine the predictive value of sequential or cross-sectional images by identifying changes in specific retinal layers, rather than total retinal thickness.…”

Section: Future Directions and Conclusionmentioning

confidence: 99%

“…These data, in particular, will define the early natural history of hydroxychloroquine retinopathy. For example, sequential retinal thickness measurements appear to be in part predictive of the development of retinopathy by current definitions ( 20 ). Other novel imaging modalities may further qualify the early natural history of retinopathy (i.e., that precede visual field changes).…”

Section: Future Directions and Conclusionmentioning

confidence: 99%

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Novel imaging techniques for hydroxychloroquine retinopathy

2022

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Hydroxychloroquine retinopathy is an increasingly recognized cause of iatrogenic, irreversible visual impairment due to the expanding use of hydroxychloroquine in combination with improvements in disease detection following advances in retinal imaging techniques. The prevalence of disease is estimated to be greater than 5% amongst individuals who have used the drug for 5 years or more. In addition to conventional imaging modalities, such as spectral-domain optical coherence tomography (OCT) and fundus autofluorescence (FAF), novel retinal imaging techniques such as en face OCT, OCT angiography, fluorescence lifetime imaging ophthalmoscopy, quantitative autofluorescence, and retromode imaging are capable of detecting structural changes in the retina. These novel retinal imaging techniques have shown promise in detecting earlier disease than is possible with current mainstream imaging modalities. Moreover, these techniques may identify disease progression as well as enabling functional correlation. In the future, these novel imaging techniques may further reduce the risk of visual loss from hydroxychloroquine retinopathy through the earlier detection of pre-clinical disease.

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Exogen bedingte Retinopathien

Kellner,

Weinitz

et al. 2023

Springer Reference Medizin

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Rapid Macular Thinning Is an Early Indicator of Hydroxychloroquine Retinal Toxicity

Cited by 15 publications

References 26 publications

Retinal microvascular density analysis in patients with rheumatoid arthritis treated with hydroxychloroquine

Retinal microvascular density analysis in patients with rheumatoid arthritis treated with hydroxychloroquine

Novel imaging techniques for hydroxychloroquine retinopathy

Exogen bedingte Retinopathien

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