New insights in pathogenic mechanism  of hydroxychloroquine retinal toxicity through optical coherence tomography angiography analysis

Sargues, Lidia Remolí; Adsuara, Clara Monferrer; Navarro, V. Castro; Garfella, M.L. Hernández; Bel, L. Hernández; Palop, Catalina Navarro; Hernández, Juan Antonio Rodríguez; Taulet, Enrique Cervera

doi:10.1177/11206721221076313

Cited by 11 publications

(6 citation statements)

References 24 publications

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“…Some scholars have speculated that the retinal toxicity of hydroxychloroquine may not be mediated by blood vessels. 24 The retinal blood flow changes found in our study may be the joint effect of the disease itself and hydroxychloroquine. Future research could include children with extremely short disease durations to avoid the interference of hydroxychloroquine.…”

Section: Discussionmentioning

confidence: 54%

Subclinical macular vessel density alterations in patients with juvenile systemic lupus erythematosus

Xu,

Zhang

2023

Lupus

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Objective The aim is to evaluate subclinical alterations of macular microvasculature in patients with juvenile systemic lupus erythematosus (JSLE). Methods This is a cross-sectional study of 29 eyes of 29 patients diagnosed with JSLE and 29 eyes of 29 healthy controls. The vessel density (VD) of the superficial capillary plexus (SCP), intermediate capillary plexus (ICP), deep capillary plexus (DCP), choriocapillaris (CC), and area of foveal avascular zone (FAZ) was measured using optical coherence tomography angiography (OCTA). A multiple linear regression analysis was performed to evaluate the effects of disease duration and activity on OCTA parameters. Results The VD of total ( p = .007) and the superior ( p = .014) and inferior ( p = .004) quadrants in SCP was significantly lower in children with JSLE. The VD of total and all quadrants in ICP decreased ( p = .015, p = .0045, p = .015, p = .033), except that of the temporal quadrant ( p = .366). The total ( p = .011) and superior quadrant ( p<.01) DCP-VD showed a significant decrease in children with JSLE. The decrease in VD in the total ( p = .003) and nasal quadrant ( p = .017) of CC was also remarkable. No significant difference in the FAZ area was found between the two groups ( p = .774). Multiple linear regression analyses adjusted for age, spherical equivalent, and intraocular pressure were conducted. No contributing factor to OCTA parameters was found. Conclusions We demonstrated decreased VD in all layers of the retina and CC in patients with JSLE without ocular involvement. Early screening and close follow-up were recommended.

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Section: Discussionmentioning

confidence: 54%

Subclinical macular vessel density alterations in patients with juvenile systemic lupus erythematosus

Xu,

Zhang

2023

Lupus

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“…Our results showed that DVD demonstrated a negative correlation with HCQ treatment, which was similar to Forte et al.’s study ( 19 ). While some researchers observed an increase of VD in patients who underwent HCQ treatment or no significant differences ( 33 , 34 ).…”

Section: Discussionmentioning

confidence: 95%

Quantitative assessment of retinal vasculature changes in systemic lupus erythematosus using wide-field OCTA and the correlation with disease activity

Meng,

Chen,

Zhang

et al. 2024

Front. Immunol.

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PurposeTo assess the retinal vasculature changes quantitatively using wide-field optical coherence tomography angiography (OCTA) in systemic lupus erythematosus (SLE), and explore its correlation with systemic clinical features.DesignProspective, cross-sectional, observational study.Participants and controlsPatients with SLE who presented to the Ophthalmology Department of Peking Union Medical College Hospital from November 2022 to April 2023 were collected. The subjects were divided into retinopathy and without retinopathy groups. Age and gender-matched healthy subjects were selected as controls.MethodsPatients with SLE and control subjects were imaged with 24×20 mm OCTA scans centered on the fovea and 6×6 mm OCTA scans centered on the optic disc. The sub-layers of OCTA images were stratified by the built-in software of the device and then the retinal thickness and vessel density were measured automatically. The characteristics of retinal OCTA parameters of SLE and its correlation with systemic clinical indicators of patients without retinopathy were analyzed.Main outcome measuresOCTA parameters, visual acuity, intraocular pressure, and systemic clinical indicators of patients such as disease activity index, autoimmune antibodies, and inflammatory marker levels were collected.ResultsA total of 102 SLE patients were included, 24 of which had retinopathy, and 78 had unaffected retina. Wide-field OCTA could effectively detect retinal vascular obstruction, non-perfusion area, and morphological abnormalities in patients with lupus retinopathy. SLE patients without retinopathy had significantly higher retinal superficial vessel density (SVD) in foveal (P=0.02), para-foveal temporal (P=0.01), nasal (P=0.01), peripheral foveal temporal (P=0.02), and inferior areas (P=0.02), as well as subregion temporal (P=0.01) and inferior areas (P=0.03) when compared with healthy controls (n=65 eyes from 65 participants). The area under curve (AUC) value of subregion inferior SVD combined parafoveal temporal SVD was up to 0.70. There was a significantly positive correlation between SVD and disease activity in SLE without retinopathy group. Patients with severe activity had the most significant increase in SVD.ConclusionWide-field OCTA can provide a relatively comprehensive assessment of the retinal vasculature in SLE. In the absence of pathological changes of the retina, the SVD was significantly increased and was positively correlated with the disease activity of SLE.

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“…However, Remolí Sargues et al . [ 24 ] found very conflicting results in their retrospective study and suggested that HCQ retinal toxicity is not vascular-mediated.…”

Section: Discussionmentioning

confidence: 99%

Optical coherence tomography angiography parameters in patients taking hydroxychloroquine therapy

Vasilijević,

Kovačević,

Dijana

et al. 2023

Indian Journal of Ophthalmology

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Purpose: The aim of this study is to measure retinal vessel density and flow rate area by optical coherence tomography angiography (OCTA) in patients with autoimmune diseases taking hydroxychloroquine (HCQ). Methods: The cross-sectional study included 98 patients divided into three groups. Group I included patients with the diagnosis of an autoimmune disease, for whom the introduction of HCQ was planned. Group II implied low-risk patients for retinal toxicity (≤5 years of HCQ use), whereas Group III implied patients that were at high-risk (>5 years of drug use). All patients underwent a computerized visual field, central macular thickness by optical coherence tomography, and OCTA measurements. Results: The vascular density was found to be statistically significantly decreased in the high-risk group compared to the control group in the superficial parafoveal zone (P = 0.030), whereas it was decreased compared to the low-risk and control groups in the deep layers whole (P = 0.006, P = 0.010, respectively) and perifoveal zones (P = 0.003, P = 0.010, respectively). The foveal avascular zone was significantly enlarged in the high-risk group compared to the control (P < 0.018). Retinal flow rates did not show statistically significant differences between the groups (P > 0.05). Conclusion: Patients treated with HCQ for more than 5 appear have a significant loss of vascular density in the parafoveal and perifoveal regions, and FAZ area is significantly increased compared to low-risk patients and controls. These findings indicate that OCTA may be beneficial for monitoring high-risk patients and may stratify their risk of further retinal damage.

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New insights in pathogenic mechanism of hydroxychloroquine retinal toxicity through optical coherence tomography angiography analysis

Cited by 11 publications

References 24 publications

Subclinical macular vessel density alterations in patients with juvenile systemic lupus erythematosus

Subclinical macular vessel density alterations in patients with juvenile systemic lupus erythematosus

Quantitative assessment of retinal vasculature changes in systemic lupus erythematosus using wide-field OCTA and the correlation with disease activity

Optical coherence tomography angiography parameters in patients taking hydroxychloroquine therapy

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