Outer Nuclear Layer Damage for Detection of Early Retinal Toxicity of Hydroxychloroquine.

Alfonso Casado,Soraya Fonseca,Miguel A Gordo-Vega,Alicia López-De-Eguileta,Pedro Muñoz,Andrea Cerveró,Rosalía Demetrio

doi:10.3390/biomedicines8030054

Alfonso Casado, Soraya Fonseca + Show 5 more

Open Access

https://doi.org/10.3390/biomedicines8030054

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Abstract

In hydroxychloroquine (HCQ) retinopathy, early detection of asymptomatic retinal changes and the interruption of the drug are essential to prevent permanent vision loss. Our purpose was to investigate the roles of ganglion cell layer (GCL) and outer nuclear layer (ONL) thicknesses measured by optical coherence tomography (OCT) in the early diagnosis of retinopathy. One hundred and fourteen eyes of 76 individuals with HCQ treatment were enrolled in the study (42 eyes with impaired visual field (VF) and 72 eyes with nondamaged VF). We found that ONL was significantly decreased in the HCQ retinopathy group compared with the control group in the nasal macula (p = 0.032) as well as in four sectors (p < 0.044), whereas no significant differences were found comparing GCL in both groups. If VF were altered superiorly or temporarily, ONL was significantly thinned inferiorly (p = 0.029) and nasally (p = 0.008), respectively. Duration of HCQ treatment was significantly related with ONL in seven sectors of ONL (p < 0.047). We suggest that ONL measured with OCT might be used to assess early HCQ retinal toxicity.

Highlights

Hydroxychloroquine (HCQ) is a 4-aminoquinoline agent and a hydroxylation compound of chloroquine that was first used to prevent or to treat malarial infections
Since retinal layers’ thicknesses are related with glaucoma and other various retinal pathologies, we excluded all eyes with ocular diseases, as well as clinically relevant opacities of the optic media and low-quality images due to unstable fixation, or severe cataract
Evidence sufficiently supports the use of HCQ in systemic lupus erythematosus (SLE), as it has been proved that HCQ improves the disease activity and allows the reduction of the corticosteroid dose regardless of background treatment [16], as well as that the adherence to HCQ improves long-term survival [17]

Summary

Introduction

Hydroxychloroquine (HCQ) is a 4-aminoquinoline agent and a hydroxylation compound of chloroquine that was first used to prevent or to treat malarial infections. The importance of this drug today is the extended use of it in the treatment of plural rheumatic disorders, especially in rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE) [1,2]. This drug has deeply proved its benefits [1,2], the prolonged use of HCQ might cause retinal damage as an important side effect, which is known as chloroquine retinopathy, as it was first described with the use of chloroquine [3]. Corneal chloroquine or HCQ has been related as well with retinopathy, but this theory has not been widely extended [5]

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