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Negin Agange, Gelareh Abedi, Joseph M Harrison; Multifocal electroretinography (mfERG) findings in patients with long-term hydroxychloroquine (plaquenil) use and suspected toxicity. Invest. Ophthalmol. Vis. Sci. 2014;55(13):4882.
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This is a retrospective chart review of patients on plaquenil who had mfERG compared to age-matched normal mfERG controls. The objective is to study patients with abnormal mfERG on plaquenil to detect differences in mfERG pattern changes in patients for plaquenil toxicity compared to controls.
Institutional IRB approval was obtained prior to study. Two-hundred and fifty plaquenil mfERG reports were reviewed and of those, ninety-one charts of patients on plaquenil were selected for being abnormal. Of the ninety-one patients, thirteen sets of eyes met the inclusion criteria. Data collected included other medical diagnoses, number of years on plaquenil, age, gender, BMI, cumulative dose, baseline visual acuity, HVF 10-2, mfERG with 106 hexagon, ring 1 through 6 and ratios (1:2; 1:3; 1:4; 1:6; 2:6) were entered into excel database and statistical analysis using excel was done. For control group, patients on plaquenil with normal mfERG and no evidence of toxicity on biomicroscopy fundus examination and normal HVF and normal visual acuities were used. High definition OCT was not available at the time of patient evaluations and follow up.
The average age of study population was 56 with females compromising 78%. Systemic Lupus Erythematous made up 77% of the population and 39% of the subjects were on plaquenil for more than 10 years. The average accumulative dose was 786 grams (SD: 921, CI: 229- 1342). The average BMI was 28 (SD: 7.2; CI: 24 -33). The average baseline logMAR visual acuity of the right eye was 0.06 and 0.02 for the left eye. The average logMAR visual acuity at time of suspected toxicity in the right eye was 0.06 and 0.05 in the left eye, and were not significantly different from baseline (p = 0.97 and 0.58, respectively). At the time of suspected toxicity, only one subject had abnormal HVF 10-2 and one had detected maculopathy on biomicroscopy exam. However, all thirteen sets of eyes had at least one abnormal ring amplitude on mfERG at the time of suspected toxicity. The rate of abnormal values for ring amplitude and ratio in the right and left eye were 63%, 74%, 15%, and 12% respectively. All these values were significantly different from 0, p<0.0001.
Our limited data shows that among the ring amplitudes, ring 1 seems to be the most sensitive for detecting early toxicity; however, this needs to be investigated further.
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