July 2019
Volume 60, Issue 9
Free
ARVO Annual Meeting Abstract  |   July 2019
Long-Term Longitudinal Ellipsoid Zone Mapping on Spectral Domain OCT in Eyes with Hydroxychloroquine Use to Evaluate for Subclinical Outer Retinal Alterations: A Possible Early Marker for Toxicity
Author Affiliations & Notes
  • Katherine Elizabeth Talcott
    Cole Eye Institute, Cleveland Clinic, Ohio, United States
  • Atsuro Uchida
    Cole Eye Institute, Cleveland Clinic, Ohio, United States
  • Ming Hu
    Cole Eye Institute, Cleveland Clinic, Ohio, United States
  • Obinna Ugwuegbu
    Cole Eye Institute, Cleveland Clinic, Ohio, United States
  • Sunil K Srivastava
    Cole Eye Institute, Cleveland Clinic, Ohio, United States
  • Rishi P Singh
    Cole Eye Institute, Cleveland Clinic, Ohio, United States
  • Stephanie Kaiser
    Cole Eye Institute, Cleveland Clinic, Ohio, United States
  • Natalia Albuquerque Lucena Figueiredo
    Cole Eye Institute, Cleveland Clinic, Ohio, United States
  • Alison Rogozinski
    Cole Eye Institute, Cleveland Clinic, Ohio, United States
  • Thuy Le
    Cole Eye Institute, Cleveland Clinic, Ohio, United States
  • Leina Lunasco
    Cole Eye Institute, Cleveland Clinic, Ohio, United States
  • Jamie L. Reese
    Cole Eye Institute, Cleveland Clinic, Ohio, United States
  • Justis P Ehlers
    Cole Eye Institute, Cleveland Clinic, Ohio, United States
  • Footnotes
    Commercial Relationships   Katherine Talcott, None; Atsuro Uchida, None; Ming Hu, None; Obinna Ugwuegbu, None; Sunil Srivastava, Allergan (F), Bausch and Lomb (C), Gilead (F), Leica (P), Regeneron (F), Santen (C); Rishi Singh, Alcon (F), Apellis (F), Genentech (C), Genentech (F), Optos (C), Regeneron (C), Regeneron (F), Shire (C), Zeiss (C); Stephanie Kaiser, None; Natalia Figueiredo, None; Alison Rogozinski, None; Thuy Le, None; Leina Lunasco, None; Jamie Reese, None; Justis Ehlers, Aerpio (C), Aerpio (F), Alcon (C), Alcon (F), Alimera (C), Allergan (C), Boerhinger Ingelheim (F), Genentech (C), Leica (C), Leica (P), Novartis (C), Novartis (F), Regeneron (F), Roche (C), Santen (C), Thrombogenics (C), Thrombogenics (F), Zeiss (C)
  • Footnotes
    Support  NIH/NEI K23-EY022947-01A1, RPB Institutional Grant
Investigative Ophthalmology & Visual Science July 2019, Vol.60, 1854. doi:
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      Katherine Elizabeth Talcott, Atsuro Uchida, Ming Hu, Obinna Ugwuegbu, Sunil K Srivastava, Rishi P Singh, Stephanie Kaiser, Natalia Albuquerque Lucena Figueiredo, Alison Rogozinski, Thuy Le, Leina Lunasco, Jamie L. Reese, Justis P Ehlers; Long-Term Longitudinal Ellipsoid Zone Mapping on Spectral Domain OCT in Eyes with Hydroxychloroquine Use to Evaluate for Subclinical Outer Retinal Alterations: A Possible Early Marker for Toxicity. Invest. Ophthalmol. Vis. Sci. 2019;60(9):1854.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : Loss of ellipsoid zone (EZ) integrity on optical coherence tomography (OCT) is a hallmark feature of hydroxychloroquine (HCQ) toxicity but early alterations can be subtle. The purpose of this study is to evaluate longitudinal changes on OCT that may precede clinical HCQ toxicity using a semi-automated EZ mapping platform.

Methods : This study was an IRB-approved retrospective image analysis of patients currently taking HCQ who had OCTs at two time points. Patients with concurrent macular disease were excluded. The two macular cube scans were exported and analyzed in the EZ mapping platform. Seven outer retinal parameters were utilized to evaluate for subtle alterations over time: mean parafoveal (central 2-mm) ONL-EZ thickness/volume, mean parafoveal EZ-RPE thickness/volume, en face percentage of EZ total attenuation (EZ thickness = 0μm), en face EZ attenuation (EZ thickness < 20μm). Outputs were compared between scans using paired t-tests.

Results : Four hundred one eyes of 401 subjects were included. Mean age was 57.6±0.2 years, mean daily HCQ dose was 367.1±72.6 mg, and mean HCQ dose based on actual body weight was 4.9±1.8 mg/kg. At time of the first OCT, mean duration of HCQ use was 5.8±3.9 years and cumulative HCQ dose was 2.1±1.5 grams. Mean time between the two OCT time points was 3.1±0.9 years. There was a significant increase in en face EZ attenuation from the first OCT (1.4±5.6%) to the second OCT (1.8±6.3%; p=0.01). The increase in EZ loss significantly correlated with age (p=0.04), drug duration (p=0.004), and cumulative dose (p=0.002), but not daily dose (p=0.24) or dose based on actual body weight (p=0.11). There was also an increase in en face EZ total attenuation between the 2 OCTs (0.9±5.0% vs 1.1±5.3%) but this was non-significant (p=0.08). There was no significant longitudinal change in mean parafoveal (central 2-mm) ONL-EZ thickness/volumes or EZ-RPE thickness/volumes (all p>0.09).

Conclusions : Longitudinal assessment of outer retinal integrity revealed a significant increase in EZ attenuation which correlated with age, cumulative dose, and duration on drug. Additional research is needed to further validate these subclinical progressive changes and their impact on identification of HCQ toxicity.

This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.

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