Early hydroxychloroquine retinopathy: optical coherence tomography abnormalities preceding Humphrey visual field defects.
Adult
Aged
Antirheumatic Agents
/ toxicity
Chronic Disease
Early Diagnosis
Electroretinography
Female
Humans
Hydroxychloroquine
/ toxicity
Male
Middle Aged
Optical Imaging
Retina
/ diagnostic imaging
Retinal Diseases
/ chemically induced
Retrospective Studies
Tertiary Care Centers
Tomography, Optical Coherence
Vision Disorders
/ chemically induced
Visual Acuity
/ physiology
Visual Field Tests
Visual Fields
/ drug effects
diagnostic tests/Investigation
drugs
imaging
macula
retina
Journal
The British journal of ophthalmology
ISSN: 1468-2079
Titre abrégé: Br J Ophthalmol
Pays: England
ID NLM: 0421041
Informations de publication
Date de publication:
11 2019
11 2019
Historique:
received:
09
10
2018
revised:
02
01
2019
accepted:
04
01
2019
pubmed:
2
3
2019
medline:
30
5
2020
entrez:
2
3
2019
Statut:
ppublish
Résumé
Hydroxychloroquine (HCQ) retinopathy may result in severe and irreversible vision loss, emphasising the importance of screening and early detection. The purpose of this study is to report the novel finding of early optical coherence tomography (OCT) abnormalities due to HCQ toxicity that may develop in the setting of normal Humphrey visual field (HVF) testing. Data from patients with chronic HCQ exposure was obtained from seven tertiary care retina centres. Ten patients with HCQ-associated OCT abnormalities and normal HVF testing were identified. Detailed analysis of the OCT findings and ancillary tests including colour fundus photography, fundus autofluorescence, multifocal electroretinography and microperimetry was performed in these patients. Seventeen eyes from 10 patients illustrated abnormalities with OCT and normal HVF testing. These OCT alterations included (1) attenuation of the parafoveal ellipsoid zone and (2) loss of a clear continuous interdigitation zone. Several eyes progressed to advanced parafoveal outer retinal disruption and/or paracentral visual field defects. Patients with high risk HCQ exposure and normal HVF testing may develop subtle but characteristic OCT abnormalities. This novel finding indicates that, in some cases of early HCQ toxicity, structural alterations may precede functional impairment. It is therefore important to employ a screening approach that includes OCT to assess for these early findings. Ancillary testing should be considered in cases with suspicious OCT changes and normal HVFs.
Sections du résumé
BACKGROUND/AIMS
Hydroxychloroquine (HCQ) retinopathy may result in severe and irreversible vision loss, emphasising the importance of screening and early detection. The purpose of this study is to report the novel finding of early optical coherence tomography (OCT) abnormalities due to HCQ toxicity that may develop in the setting of normal Humphrey visual field (HVF) testing.
METHODS
Data from patients with chronic HCQ exposure was obtained from seven tertiary care retina centres. Ten patients with HCQ-associated OCT abnormalities and normal HVF testing were identified. Detailed analysis of the OCT findings and ancillary tests including colour fundus photography, fundus autofluorescence, multifocal electroretinography and microperimetry was performed in these patients.
RESULTS
Seventeen eyes from 10 patients illustrated abnormalities with OCT and normal HVF testing. These OCT alterations included (1) attenuation of the parafoveal ellipsoid zone and (2) loss of a clear continuous interdigitation zone. Several eyes progressed to advanced parafoveal outer retinal disruption and/or paracentral visual field defects.
CONCLUSION
Patients with high risk HCQ exposure and normal HVF testing may develop subtle but characteristic OCT abnormalities. This novel finding indicates that, in some cases of early HCQ toxicity, structural alterations may precede functional impairment. It is therefore important to employ a screening approach that includes OCT to assess for these early findings. Ancillary testing should be considered in cases with suspicious OCT changes and normal HVFs.
Identifiants
pubmed: 30819690
pii: bjophthalmol-2018-313350
doi: 10.1136/bjophthalmol-2018-313350
doi:
Substances chimiques
Antirheumatic Agents
0
Hydroxychloroquine
4QWG6N8QKH
Types de publication
Case Reports
Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
1600-1604Informations de copyright
© Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.
Déclaration de conflit d'intérêts
Competing interests: NKW is a consultant for Optovue and receives research support from Carl Zeiss Meditec, Topcon Medical Systems and Nidek Medical Products. JSD is a consultant for and receives research support from Carl Zeiss Meditec and Optovue. EHS is a consultant for Novartis, Bayer Schering Pharma, Allergan Inc. and Farmila-Thea. KBF is a consultant to Genentech, Allergan, Optos, Optovue, Zeiss, Heidelberg Engineering and Novartis. He receives research funding from Genentech/Roche. DS is a consultant for Amgen, Bayer, Genentech, Novartis and Optovue and receives research funding from Genentech, Heidelberg, Optovue and Regeneron. All other authors have no conflict of interest to declare.