Retinal tomographic changes associated with hydroxychloroquine (HCQ) in patients with early functional retinal damage

Author: Raquel Maroto Cejudo (Spain)

Co-authors: Sergio Copete Piqueras, Antonio Donate Tercero, Carlos Cava Valenciano, Francisco López Martinez, Gregorio García García, Cristina Blanco Marchite

Purpose

To evaluate retinal layer thickness using spectral-domain optical coherence tomography (SD-OCT) in patients under HCQ treatment, depending on the presence of multifocal electroretinogram (mfERG) alteration

Setting/Venue

Transversal study that included tomographic analysis of patients under treatment with HCQ for at least 5 years or with risk factors associated, that underwent mfERG study.

Methods

Tomographic images obtained with SD-OCT were automatically segmented. Visual field and autofluorescence were also performed. Eyes were divided according to the presence or absence of early alterations in the mfERG. p value <0.05 was considered statistically significant.

Results

78 eyes of 39 patients with a mean age of 54.8 ± 15.4 years were included. 40 eyes presented incipient retinal toxicity in the mfERG, with a mean duration of HCQ treatment of 8 ± 4.4 years. No difference in age between groups was observed. Any patient without damage in the mfERG secondary to HCQ showed alteration in the visual field, autofluorescence or the external retina, while in the mfERG affected group 11 patients had damage in the visual field, 6 in the autofluorescence and 2 in the external retina. Total retinal thickness was lower in patients with central mfERG and external ring damage. There were statistically significant differences in the following layers: Ganglion cells (external ring), internal plexiform (external ring), internal nuclear (lower), and external plexiform (lower and temporal). There were no differences in the outer nuclear layer neither the pigment epithelium of the retina.

Conlusions

Early damage in the multifocal electroretinogram caused by the administration of hydroxychloroquine is accompanied by a thinning of the internal retina from very early stages, even before being able to appreciate the tomographic changes described in the external retina.

Financial Disclosure

No financial relations