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Victoria Radun, Andreas Berlin, Clara Reichel, Nikolai Kleefeldt, Ioana-Sandra Tarau, Jost Hillenkamp, KENNETH R SLOAN, Thomas Ach; Quantitative fundus autofluorescence (QAF) in chloroquine/hydroxychloroquine (CQ/HCQ) patients: one-year follow-up.. Invest. Ophthalmol. Vis. Sci. 2020;61(7):5262.
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Chronic CQ/HCQ intake can cause severe ocular side effects including bull’s-eye maculopathy (BEM). Recommended retinal screening (PMID: 26992838) includes fundus autofluorescence (FAF) to detect early changes at the photoreceptor/retinal pigment epithelium level. QAF, an advancement in FAF imaging, enables comparison of AF intensities (PMID: 22016060), even in longitudinal settings. Here, QAF in CQ/HCQ patients in a one year follow-up is reported.
Twenty-eight eyes from 28 patients (range: 31-74 yrs, clear media) currently or previously treated with CQ/HCQ (cumulative doses up to 2373.8 g) underwent multimodal imaging (infrared, red free, AF (488, 787 nm), QAF (488 nm) and spectral-domain optical coherence tomography (Spectralis/modified HRA2, Heidelberg Engineering)) one year after baseline examination. Fifty-two age-matched healthy subjects served as controls. Custom written FIJI plugins enabled QAF image processing (adjustment to the device’s internal reference, age-related subject’s optical density) and QAF values calculation. QAF intensities are reported as mean QAF8 ± standard deviation in arbitrary units (PMID: 23860757). One sided Student’s t-test (normal data distribution) was used for statistical analysis.
The patients (26 with no signs of CQ/HCQ maculopathy, 2 with BEM) were followed for a mean of 11.5 months (range: 8-18 months). Mean QAF8 values increased significantly from 305.9±71.6 at baseline to 331.4±86.4 at follow-up (p<0.005). Maximum changes in QAF8 intensity were observed at the temporal-superior perifovea. Seventeen subjects were within a ±10 % QAF8 value range compared to baseline, while 11 patients showed ΔQAF8 >10% (10-58 %). Increase of QAF8 seems to be dose-dependent (daily dose range: 0-400 mg). Compared to healthy subjects, QAF8 values are significantly higher in CQ/HCQ patients (p<0.001). Results from other imaging modalities were unremarkable for patients without maculopathy.
QAF might be a useful imaging tool in baseline and follow-up examination of CQ/HCQ patients. Interestingly, CQ/HCQ patients show increased QAF throughout the posterior pole (as previously reported, IOVS, 2019:1585-1585), though structural and functional retina tests are normal. This trend also continues in the one year follow-up. Whether high QAF increase might lead to degeneration or BEM is currently investigated in ongoing studies.
This is a 2020 ARVO Annual Meeting abstract.
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