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

Casado, Alfonso; López-de-Eguileta, Alicia; Fonseca, Soraya; Muñoz-Cacho, Pedro; Demetrio, Rosalía; Gordo-Vega, Miguel Angel; Cerveró, Andrea

doi:10.3390/biomedicines8030054

Cited by 10 publications

(10 citation statements)

References 26 publications

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“…To the best of our knowledge, there are no other studies in the current literature that show an anatomically damaged retinal layer in Tacrolimus-associated maculopathy. This finding is consistent with the recent results of Casado et al [ 13 ], that studied retinal damage in individuals with Hydroxychloroquine treatment. They found that ONL thickness was significantly decreased in patients taking Hydroxychloroquine compared with the control group.…”

Section: Discussionsupporting

confidence: 94%

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A Case of Tacrolimus Maculopathy

Santarelli

Zeppieri

Salati

2022

Clinics and Practice

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(1) Background: Tacrolimus is an immunosuppressive agent commonly used in the management of solid organ allogeneic transplants in the prevention of rejection. Serious ophthalmic adverse effects with Tacrolimus have been reported in the literature, which includes cortical blindness and optic neuropathy. (2) Methods: We describe a rare case of maculopathy as a possible complication of Tacrolimus therapy. A 56-year-old man receiving Tacrolimus for immunosuppression after liver transplantation developed unilateral visual disturbance with a central scotoma. (3) Results: Ophthalmologic examination revealed unilateral maculopathy; a Tacrolimus macular toxicity was suspected. After drug discontinuation, a complete visual recovery was observed; however, the ultrastructural macular damage was irreversible. (4) Conclusions: Reports regarding maculopathy associated with Tacrolimus are limited. This case report adds to the current literature regarding the possible macular toxicity of this immunosuppressive agent, especially if it exceeds therapeutic serum levels. Further data are needed to confirm this possible association. A careful ophthalmologic examination should be promptly performed in patients manifesting visual disturbance while taking Tacrolimus to prevent irreversible, permanent vision loss due to possible drug toxicity.

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Section: Discussionsupporting

confidence: 94%

“…The case reported by Taehuk et al [ 9 ] and the study of Casado et al [ 13 ] were key in our suspect diagnosis. The elevation of Tacrolimus plasma level in our patients directed us toward the hypothesis of Tacrolimus induced maculopathy.…”

Section: Discussionmentioning

confidence: 66%

A Case of Tacrolimus Maculopathy

Santarelli

Zeppieri

Salati

2022

Clinics and Practice

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“…Life threatening arrhythmias associated with CQ and HCQ appear to be rare but if these drugs were to be used much more extensively then caution and appropriate monitoring are necessary [36,37]. Patients and their physicians prescribing HCQ need to be keenly aware of retinal toxicity risks and the importance of regular screening, and ophthalmologists who see these patients should keep retinal toxicity in the front of their minds [38][39][40]. However, chronic use of HCQ can result in an acquired lysosomal storage disorder, leading to a drug-induced cardiomyopathy characterized by concentric hypertrophy and conduction abnormalities associated with increased adverse clinical outcomes and mortality [41].…”

Section: Discussionmentioning

confidence: 99%

Febuxostat as an alternative therapy in COVID-19: A double-blind randomized clinical trial

Davoodi

Abedi

Salehifar

et al. 2020

Preprint

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Aims: The aim of this double-blind randomized clinical trial was to determine the effects of FBX in comparison with hydroxychloroquine (HCQ) on clinical symptoms, laboratory tests and chest CT findings in patients with COVID-19-causing moderate symptomatic disease. Methods: We conducted a randomized, double blind clinical trial involving adult outpatients' patients with COVID-19 infection, which causes the moderate respiratory illness. Sixty patients were randomly assigned to receive either FBX or HCQ for 5 days. The measured variables were clinical and laboratory data including rate of fever, cough, berating rate, C-Reactive Protein level, lymphocytes count at onset of admission and was well as at 5 days of treatments. In addition, CT lesions were evaluated on admission and 14 days of treatments in both groups. Results: Fever, cough and tachypnea significantly mitigated in both groups after five days of treatments. The lymphocytes count significantly increased in both treatment groups and the CRP values were dropped in normal range (negative) in major of patients receiving FBX or HCQ treatment. It was not observed any significantly difference between FBX and HCQ in frequency of these symptoms. The mean percentages of CT abnormality scores were significantly reduced to 7.3% and 8% after 14 days of FBX and HCQ treatments, respectively. In adult outpatients with moderate symptomatic Covid-19, the effectiveness of FBX was same to HCQ in improvement of clinical manifestations, laboratory tests and CT lesions. Conclusion: These findings suggest FBX as an alternative treatment for Covid-19 infection in patients with contraindication or precaution to HCQ.

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“…These changes are visible in SD-OCT. The disruption of the ellipsoid zone and the loss of the outer nuclear layer (ONL) 11 , 19 cause a collapse of the parafoveal retina, which can lead to a “flying saucer” appearance of the fovea 20 . These structural changes in the outer retina usually correlate with functional changes shown in multifocal electroretinograms (mERGs) and changes in the visual field 10 , 11 .…”

Section: Introductionmentioning

confidence: 99%