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David Ryan Lally, Steven Maler, Igor I Bussel, Andre J Witkin, Elias Reichel, Chirag Shah, Jeffrey Heier, Jay S Duker; Evaluation of Spectral-domain Optical Coherence Tomography in Patients with Hydroxychloroquine Retinal Toxicity after Drug Cessation. Invest. Ophthalmol. Vis. Sci. 2014;55(13):4879.
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Hydroxychloroquine (HCQ) is a common therapy in rheumatologic disease, especially systemic lupus erythematosus. The central concern with hydroxychloroquine has been its potential for retinal toxicity. Retinal toxicity changes are generally thought to be irreversible, and therefore early detection is critical in preventing debilitating vision loss. Hence, the focus of many reports in the literature is on early detection. Few reports, however, have examined changes in the retina after drug cessation. In this study, we examined changes in spectral-domain optical coherence tomography (SD-OCT) over time in patients with HCQ retinal toxicity who have discontinued the medication.
A retrospective review of 28 eyes of 14 patients with HCQ retinal toxicity who were followed after drug cessation. Retinal toxicity was diagnosed with clinical examination, multifocal electroretinogram (mfERG), SD-OCT, fundus autofluorescence, and/or visual field. Evaluation of total macular volume, retinal thickness in each of the 9 SD-OCT subfields, and qualitative analysis of 1-line scans through the fovea were performed.
This study included 14 patients with HCQ retinal toxicity with a median age of 70 (range 49 - 76). The median follow up was 36 months (range 2 - 96). The average cumulative dose of HCQ was 1080 grams (range 347 - 2482). The SD-OCT central subfoveal thickness decreased an average of 12.32 µm after drug cessation. The greatest change in subfield SD-OCT thickness was in the outer nasal region with an average decrease of 18.8µm, while the outer superior subfield showed the smallest change in thickness with an average decrease of 5.04µm after drug cessation. Total macular volume decreased on average 0.48 mm^3 per year.
Previous studies have shown decreased parafoveal retinal thickness in HCQ toxicity. This study is the first to show patients with HCQ retinal toxicity on average had a progressive decline in total macular volume and retinal thickness in each of the 9 SD-OCT subfields over time after drug cessation. Further structural analysis of the macula beyond the parafoveal region is warranted in understanding the long-term retinal effects of HCQ after drug cessation.
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