Abstract
Purpose :
Hydroxychloroquine (HCQ) is a drug commonly used to treat a variety of autoimmune diseases, including rheumatoid arthritis and systemic lupus erythematosus. A side-effect of the medication is development of irreversible retinal damage, which progresses up to 6 months after stopping HCQ. Fluorescence Lifetime Imaging Ophthalmoscopy (FLIO) has been shown to highlight retinal changes related to HCQ toxicity. The present analysis aims to follow up on our group’s baseline study to characterize the longitudinal FLIO changes related to HCQ use in order to determine if FLIO is an effective modality for ongoing monitoring.
Methods :
28 eyes of 14 patients were investigated in this longitudinal study with a mean follow-up time of 4 years + 11 months. Clinical grading of HCQ toxicity was confirmed by retinal specialists (PSB, SDF). FLIO images of a 30° retinal field were acquired in short (498-560 nm, SSC) and long (560-720 nm, LSC) spectral wavelength channels using the same first-generation prototype Heidelberg Engineering Spectralis-based FLIO. Mean autofluorescence lifetimes (tm) were calculated and compared between baseline and follow-up visits.
Results :
Of the 4 eyes that had toxicity at baseline from patients who had stopped HCQ prior to their initial encounter, there was no significant prolongation of FLIO lifetimes in the area of toxicity (SSC: p=0.264, LSC: p=0.721). Of the 24 eyes that did not have toxicity at baseline from patients who continued to take HCQ, a significant prolongation was found in the SSC (243 ± 49 ps at baseline versus 272 ± 39 ps at follow-up, p<0.01). There was no significant prolongation in the LSC (302 ± 50 ps at baseline versus 314 ± 52 ps at follow-up). 2 eyes were excluded due to development of cataract.
Conclusions :
Patients without HCQ toxicity who continued to take HCQ showed prolonged FLIO lifetimes 4-5 five years after initial imaging. Patients with prior toxicity who did not take HCQ did not show prolongation of FLIO lifetimes. These results suggest that FLIO is a useful tool to monitor the progression of HCQ-related retinal toxicity. We aim to follow up on all patients initially included in our study to further understand the progression of retinal changes.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.