Structural and Functional Characterization of the Retinal Effects of Hydroxychloroquine Treatment in Healthy Eyes

Abstract

Purpose: To evaluate the influence of hydroxychloroquine in visual field and retinal layer thickness. Methods: This is a retrospective cross-sectional study. Patients taking hydroxychloroquine without signs of hydroxychloroquine retinopathy were included. Optical coherence tomography segmentation was used to obtain the ETDRS map thickness of each retinal layer. Groups were divided into short-term (< 5 years) and long-term (≥5 years) drug use. Results: We included 93 eyes of 93 patients (short-term: 25 eyes; long-term: 68 eyes). The inner nuclear layer (INL) was thinner in the long-term group (32.86 ± 2.12 vs. 34.14 ± 2.37 μm; p = 0.014). Considering long-term cases, the parafoveal ganglion cell layer (GCL) showed an inverse correlation with cumulative dose (r = –0.37; p < 0.001). After adjusting for confounders, parafoveal ganglion cell complex thickness was associated with cumulative dose (β = –0.239; p = 0.011). The parafoveal outer retina and visual field indices were similar between groups and did not correlate with cumulative dose. Conclusion: Hydroxychloroquine leads to progressive thinning of the parafoveal inner retina, particularly the INL and GCL. Visual field indices do not reflect the long-term effects of the drug.

Longitudinal Retinal Changes Induced by Hydroxychloroquine in Eyes without Retinal Toxicity

“…This was accompanied by a concomitant decrease in the IRL and, more specifically, the GCL. These findings are in agreement with other studies [6, 12, 14, 16-18]. However, some others deny this possibility [13, 19].…”

“…In each sector, the full retina (FR), inner retina (IRL) (from the inner limiting membrane to the external limiting membrane), outer retina (ORL) (from the external limiting membrane to the RPE), ganglion cell (GCL), and inner nuclear (INL) layer thicknesses were evaluated. The mean of the thicknesses found in the 4 sectors of each concentric ring was also determined [5, 12-14].…”

Microvasculature alterations of peripapillary retina and macula in systemic lupus erythematosus patients without ocular involvement by optical coherence tomography angiography

“…In addition, several previous studies have found that long-term HCQ treatment caused progressive thinning of the retinal nerve fiber layer. 37,38 In agreement with previous studies, we hypothesize that the alterations in retinal VD were more pronounced than the neural structural or at least affected first before seeing any changes in neural structural. Although some researchers found that FAZ area was enlarged in SLE patients, 13,14 we did not detect the changes of FAZ size, which may indicate FAZ area is not a candidate biomarker for detecting early stage of LR in SLE patients.…”

Hydroxychloroquine retinal toxicity- Can we do better with SD-OCT?

“…The parafoveal inferior area showed significant retinal thinning at 3 months and 6 months after hydroxychloroquine usage (Table 4) which corresponded to the typical pattern of this toxicity and coincided with a recent large study of patients using hydroxychloroquine for less than 5 years duration. 24 However, two studies had documented that the typical parafoveal distribution of toxicity is not common in Asians, who show a pericentral pattern of foveal thinning. 25,26 But this perifoveal pattern in the first study was observed in Korean patients while the second study although include East Asian, Southeast Asian, and Filipinos, the total percentage of Asian was only 18%.…”