Abstract
PurposeTo report expanded SD-OCT findings of HCQ retinopathy that may assist the clinician in earlier diagnosis. To characterize structural changes of HCQ retinopathy with SD-OCT after drug cessation.MethodsSetting: Private practice and academic institution. Patient Population: Patients at New England Eye Center and Ophthalmic Consultants of Boston in Boston, MA diagnosed with HCQ retinopathy and followed after drug cessation. Retrospective clinical data review by the Boston Image Reading Center. Main Outcome Measures: SD-OCT findings suggestive of HCQ retinopathy before parafoveal ellipsoid disruption. Change in SD-OCT morphological appearance and retinal thickness of each of the nine subfields corresponding to the Early Treatment of Diabetic Retinopathy Study areas.ResultsThirty eyes with HCQ retinopathy were followed with SD-OCT after drug cessation. Findings before disruption of the parafoveal EZ included parafoveal outer nuclear layer (ONL) thinning, disruption of the parafoveal interdigitation zone, and reduced reflectivity of the parafoveal EZ. In early toxicity, 75 % developed progression after drug cessation, including disruption of the parafoveal EZ and retinal pigment epithelium and thinning of the ONL. Eyes with obvious toxicity had greater inferior outer ring thinning 12 months after drug cessation compared to early toxicity (p = 0.002, 95 % CI −2 to −8 μm). In obvious toxicity, the nasal inner subfield showed more thinning than the temporal inner subfield at 12 months after drug cessation (p = 0.018, 95 % CI −1 to −8 μm).ConclusionsOnce HCQ retinopathy is diagnosed and the medication is discontinued, structural retinal changes commonly occur.
Highlights
Hydroxychloroquine (HCQ) has been used for therapy of rheumatologic disorders since the 1950s
The American Academy of Ophthalmology revised the screening guidelines in 2011 to include spectral domain-optical coherence tomography (SD-OCT), fundus autofluorescence (FAF), and multifocal ERG when available to assess the macula in patients taking HCQ [4]
This study examines longitudinal SD-OCT scans after cessation of HCQ and stratifies eyes based on severity of retinopathy to evaluate whether this plays a role in structural changes
Summary
Hydroxychloroquine (HCQ) has been used for therapy of rheumatologic disorders since the 1950s. Et al Int J Retin Vitr (2016) 2:18 limited to visual acuity, visual fields, and fundus examination to assess for progression of retinopathy These studies typically evaluated patients with advanced disease who had already developed a Bull’s eye fundus appearance. Studies reviewing mfERG and FAF after drug cessation have demonstrated both progression and improvement in retinal function in moderate to severe toxicity [8,9,10,11]. It is unclear whether less severe cases of retinopathy progress after HCQ cessation
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