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Clara Reichel, Ioana-Sandra Tarau, Nikolai Kleefeldt, Jost Hillenkamp, KENNETH R SLOAN, Thomas Ach; Quantified fundus autofluorescence (QAF) in patients with systemic chloroquin/hydroxychloroquin (CQ/HCQ) intake. Invest. Ophthalmol. Vis. Sci. 2019;60(9):1585.
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Side effects of chronic CQ/HCQ intake may lead to outer retina alterations and bulls-eye-maculopathy, as seen in fundus autofluorescence (AF) and spectral-domain optical coherence tomography (SD-OCT). QAF, a further development in AF, enables direct comparison of AF intensities among subjects. The goal is to identify impact of CQ/HCQ intake on QAF.
After written consent, 34 patients (range: 24-69 yrs, clear media) exposed to CQ/HCQ (cumulative dose 8-2007g) underwent multimodal (infrared, redfree, SD-OCT) and QAF (488nm exc.) imaging (Spectralis, modified HRA2, both Heidelberg Engineering), in addition to the recommended screening procedures by the AAO (PMID:26992838). 52 age-matched healthy subjects served as controls. Post-acquisition processing included: adjustments to the internal reference and the scaling factor, the zero laser level and the age related optical media density. Custom written FIJI plugins enabled: 1. Determination of the fovea to align and superimpose multimodal retina images based on foveal position. 2. Comparison of individual retinas with standard retinas of corresponding decades. 3. Plot parafoveal mean QAF8 values ±standard deviation (PMID: 23860757).
Of the 34 patients, 30 had normal fundus appearance, 4 had bulls-eye maculopathy. QAF8 values were significantly increased in all CQ/HCQ patients as compared to age-matched controls (301.2±75.8 vs. 232.6±75.2[a.u]., p<=.001), Figure. Furthermore, cumulative dose >1000 g showed higher QAF compared to dose <1000 g (356.2±84.7 vs. 284.3±65.7 [a.u] ; p=0.017).
This is the first report on increased QAF values in CQ/HCQ patients, as compared to controls. This effect might reflect elevated metabolic activity and a general involvement of the retina during drug intake. Whether increased QAF results in higher risk for the development of outer retinal atrophy/bulls-eye maculopathy and whether QAF should be used for screening in CQ/HCQ patients needs further evaluation in follow-up studies, currently being conducted.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.
The standard retina shows color coded QAF values of an age-matched healthy control group (left). CQ/HCQ intake leads to significantly increased QAF values, especially when cumulative doses exceed 1000g. However, high cumulative dose and increased QAF are not necessarily predictors for bulls-eye maculopathy (center, right). a.u. = arbitrary units.
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