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Hemang K. Pandya, Hunter Porter, Vinay A Shah, Nawajes A Mandal; Spectral-Domain Optical Coherence Tomography for Early Detection of Hydroxychloroquine Toxicity. Invest. Ophthalmol. Vis. Sci. 2016;57(12):295. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
Investigate and characterize retinal pathology, using Optical Coherence Tomography (OCT), in rheumatologic patients on Hydroxychloroquine (HCQ) for autoimmune disorders, such as Rheumatoid Arthritis (RA) and Systemic Lupus Erythematosus (SLE). The drug HCQ affects and reduces lysosomal function and that will affect sphingolipid metabolism and turnover. We hypothesize sphingolipid metabolite ceramide a known factor for neuronal cell death will increase in HCQ treated retinas which in turn induce neuronal cell death throughout the retina, especially, higher sphingolipid containing retinal ganglion cells (GC) and the nerve fibers. By imaging the retina of HCQ treated RA and SLE patients we will determine inner retinal effect of HCQ.
In a prospective study we recruited 15 subjects with autoimmune diseases, such as RA and SLE, being treated with HCQ, and 25 matched healthy control subjects. In a single clinic visit, we collected patient history to determine HCQ duration and dosage. We performed OCT to determine macular volume, thickness of macular GC, inner plexiform layer (IPL) and the optic nerve retinal nerve fiber layer (RNFL).
We observed a strong negative correlation between HCQ duration in months and macular volume, average macular thickness, and macular IPL and GC layer thickness, but a weak positive correlation with RNFL thickness. HCQ treated subjects had significantly reduced macular volume, and marked, albeit non-significant, reductions in IPL and GC layer thickness and average macular thickness compared to controls.
HCQ exposure results in reductions of inner retinal thicknesses in the macula. This identifies the need to reevaluate clinical practices for detecting retinal toxicity in patients being treated with HCQ.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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