Role of optical coherence tomography in the early detection of macular thinning in rheumatoid arthritis patients with chloroquine retinopathy

Abstract

Background: Chloroquine and hydroxychloroquine are drugs that are primarily used for the treatment of malaria and are also recommended for treating connective tissue disorders, autoimmune diseases, and some dermatological and inflammatory diseases. Treatment with these drugs has potential risk for the development of retinopathy, clinically characterized by bilateral pigment changes in the macula, as one serious ocular complication. The aim of this research was to evaluate the parafoveal and perifoveal macular retinal thickness, as central foveal thickness in adult patients with rheumatoid arthritis (RA) on chloroquine therapy using optical coherence tomography (OCT). Materials and Methods: In this cross-sectional study, 56 RA patients (56 eyes) were included and examined. All patients were treated with chloroquine (tablets resochin or delagil) at a dose of 250 mg/day without treatment with steroids and other immunosuppressive drugs. Patients were divided into two groups, namely, Group I patients - no visible changes in the macula (26 patients) and Group II patients- with visible changes in the macula (30 patients). The central fovea thickness and parafoveal and perifoveal retinal thickness in all quadrants were measured by OCT and compared in both groups. Results: There are a significantly higher number of eyes without thinning of the macula in Group I patients than in Group II ( P < 0.001) patients. There are a higher number of patients with recorded parafoveal thinning in Group II patients, especially in the inferior, nasal, and temporal sectors, respectively ( P < 0.05). Conclusion: Maculopathy is the main side effect of chloroquine therapy in RA patients that can be detected by OCT in the early stages of the macular involvement.

Early Optical Coherence Tomography Biomarkers for Selected Retinal Diseases—A Review

“…The localized thinning of retinal layers in the parafoveal region detected through OCT imaging confirms the early stage of toxicity before significant visual field loss was detected [82].…”

Retinal alterations in evaluation of rheumatoid arthritis with chloroquine treatment: A new approach

“…We further partitioned the OCTA images using different methods to provide more precise information and found that in the superficial retinal layers, the decrease in vessel density was mainly concentrated in the lower regions (IL, IR, I, and R) and near the foveal avascular zone (C1, C2, and C3), while in the deeper layers, the decrease in vessel density was more diffusely distributed (C1, C2, C3, C5, and C6). Most studies of chloroquine retinal toxicity have suggested that patients experience macular thinning, and Marija [28] found that this change was concentrated in the inferior, nasal, and temporal sectors. Lee [29] showed that the use of chloroquine led to a decrease in the thickness of the macular ganglion cell‐inner plexiform layer.…”

“…). Most studies of chloroquine retinal toxicity have suggested that patients experience macular thinning, and Marija [28] found that this change was concentrated in the inferior, nasal, and temporal sectors. Lee [29] showed that the use of chloroquine led to a decrease in the thickness of the macular ganglion cell-inner plexiform layer.…”

Expanding horizons for clinical applications of chloroquine, hydroxychloroquine, and related structural analogues

“…Development of the optical coherence tomography in recent times has improved the ability to detect subtle early changes of retinal pathology such as thinning of the foveal photoreceptor outer segment, thickening of the retinal pigment epithelium, and loss of the macular ganglion cell–inner plexiform layer, and so on. However, with the advent of such sensitive screening techniques it is yet to be seen whether there are distinct improvements in the clinical outcomes 14,15. The risk of retinopathy is minimal when detected early; however, the prognosis declines sharply once the reduction in the central foveal thickness and classic bull’s-eye lesion are evident 13.…”