Hydroxychloroquine and Chloroquine Retinopathy

Tsang, Adrian; Pirshahid, Sina Ahmadi; Virgili, Gianni; Gottlieb, Chloe; Hamilton, James B.; Coupland, Stuart G.

doi:10.1016/j.ophtha.2015.02.011

Cited by 52 publications

(20 citation statements)

References 42 publications

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“…Finally, ROC curve analysis shows that mfERG sensitivity is extremely high regarding P1-wave amplitude decrease and latency increase, partially confirming previously described findings of some authors,13 who indicate amplitude as the most sensitive value in detecting HCQ toxic retinopathy. We believe that this partial discordance could be ascribed to the different CDs of the drug in our group of patients compared to other clinical records.…”

Section: Discussionsupporting

confidence: 87%

Hydroxychloroquine for treatment of rheumatoid arthritis: multifocal electroretinogram and laser flare-cell photometry study

Sebastiani¹,

Fresina²,

Cellini³

et al. 2017

OPTH

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PurposeTo evaluate early changes in multifocal electroretinogram (mfERG) and subclinical aqueous humor flare and cellularity in patients receiving hydroxychloroquine (HCQ) as treatment for rheumatoid arthritis.MethodsTen patients receiving treatment with HCQ and no ophthalmic symptoms were enrolled. After complete ocular examination, mfERG and laser flare-cell photometry were performed. Patients were also divided into two subgroups with HCQ cumulative dose (CD) higher or lower than 500 g. Results obtained were compared with a control group of ten healthy subjects and statistical analysis was performed.ResultsIn patients receiving HCQ treatment, mfERG P1-wave in ring 2 showed a significant reduction in amplitude and a significant increase in latency compared to healthy control subjects, respectively resulting in 1.143 μV vs 1.316 μV (P=0.040) and 38.611 ms vs 36.334 ms (P=0.024). These changes are highly related to CD. Furthermore, when using the laser flare-cell photometry, a significant increase in aqueous humor flare and cellularity was shown in patients with CD higher than 500 g, resulting in a mean value of 14.4 ph/ms compared to 8.1 ph/ms in patients with CD lower than 500 g (P=0.0029). These reports appear highly related to CD (P=0.001). Receiver operating characteristic curve analysis showed mfERG P1-wave amplitude in ring 2 as the most sensitive value in detecting early HCQ-related retinopathy.ConclusionMfERG was shown to be a very sensitive test in detecting early retinal toxicity and should be used for the screening of patients receiving HCQ treatment. Although less sensitive, laser flare-cell photometry can provide further information to evaluate early toxic retinal cell damage.

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Section: Discussionsupporting

confidence: 87%

Hydroxychloroquine for treatment of rheumatoid arthritis: multifocal electroretinogram and laser flare-cell photometry study

Sebastiani¹,

Fresina²,

Cellini³

et al. 2017

OPTH

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“…The 10-2 visual field testing, spectral domain optical coherence tomography (OCT), and autofluorescence (AF) imaging are accepted as the main screening tools [ 3 ]. In some special circumstances, multifocal electroretinography (mfERG) might be essential also [ 11 , 12 ]. Many studies were conducted on the sensitivity and specificity of the mentioned tests.…”

Section: Introductionmentioning

confidence: 99%

Is optical coherence tomography angiography a useful tool in the screening of hydroxychloroquine retinopathy?

2020

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Purpose To detect the early changes in retinal vasculature via optical coherence tomography angiography (OCTA) by comparing the quantitative OCTA parameters in the group of patients who were using hydroxychloroquine (HCQ) or not. Methods This was a cross-sectional, comparative, and observational study. The patients who were newly or previously prescribed HCQ for an autoimmune disease were included. OCTA imaging was performed via OCT RT XR Avanti with AngioVue software (Optivue Inc, Freemont, CA). The study group had two groups: a control group (patients newly diagnosed and who were not taking any medication) and a treatment group (patients who were receiving HCQ treatment). The main outcome measure was OCTA parameters. Results A total of 102 eyes of 102 patients were included. There were 70 patients in the treatment group and 32 patients in the control group. All of the vascular density values were similar between the control and treatment groups (p [ 0.05 for all). However, the superficial whole thickness, superficial parafoveal thickness, superficial perifoveal thickness, deep whole thickness, deep parafoveal thickness, and deep perifoveal thickness were thinner in the treatment group than the control group (p \ 0.05 for all). Conclusion Vascular density parameters did not differ between the control and treatment groups. However, the retinal thickness values were lower in the treatment group.

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“…In 1999, Maturi et al [22] first performed mfERG in a HCQ-treated patient with pigment mottling in the macula in both eyes and reported a markedly decreased electrical response in the macula in both eyes. Subsequently, the other authors confirmed the value of mfERG in detecting early retinal dysfunction in CQ/HCQ toxicity before the development of fundus abnormalities or visual impairment [6,23,24,25,26,27,28,29,30]. In a study by Moschos et al [31], 4 of 11 patients under HCQ treatment had normal electrooculogram (EOG) responses but reduced mfERG responses, and 1 patient presented with subnormal EOG and normal mfERG; they concluded that mfERG may be a more sensitive method than EOG in detecting HCQ retinopathy.…”

Section: Cq and Hcq Retinopathymentioning

confidence: 87%

The Role of Multifocal Electroretinography in the Assessment of Drug-Induced Retinopathy: A Review of the Literature

Dettoraki

Moschos²

2016

Ophthalmic Res

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Multifocal electroretinography (mfERG) is an objective, noninvasive examination for the assessment of visual function. It enables the stimulation of multiple retinal areas simultaneously and recording of each response independently, providing a topographic measure of retinal electrophysiological activity in the central 40-50° of the retina. A clinical application of mfERG represents the assessment of retinal toxicity associated with systemic medications. Drug-induced retinopathy represents a disease that, although not common, requires early recognition: if not detected early, it may progress and cause irreversible retinal dysfunction with subsequent visual impairment. This review aims to evaluate the use of mfERG in the assessment of retinal dysfunction associated with various systemic pharmacological agents based on the currently available literature. The most commonly recognized systemic medications affecting retinal function are included, such as chloroquine and hydroxychloroquine, vigabatrin, deferoxamine, ethambutol, interferon-α, tamoxifen, digoxin, sildenafil, canthaxanthin, amiodarone and nefazodone. The role of mfERG in the early diagnosis of retinal toxicity and the evaluation of disease severity is reviewed, as well as its clinical value in monitoring disease progression or recovery after drug cessation.

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Hydroxychloroquine and Chloroquine Retinopathy

Cited by 52 publications

References 42 publications

Hydroxychloroquine for treatment of rheumatoid arthritis: multifocal electroretinogram and laser flare-cell photometry study

Hydroxychloroquine for treatment of rheumatoid arthritis: multifocal electroretinogram and laser flare-cell photometry study

Is optical coherence tomography angiography a useful tool in the screening of hydroxychloroquine retinopathy?

The Role of Multifocal Electroretinography in the Assessment of Drug-Induced Retinopathy: A Review of the Literature

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