Abstract
Purpose
To evaluate macular thickness profiles using spectral-domain optical coherence tomography (SDOCT) and image segmentation in patients with chronic exposure to hydroxychloroquine.
Methods
This study included eight patients with chronic exposure to hydroxychloroquine (group 1) and eight controls (group 2). Group 1 patients had no clinically evident retinal toxicity. All subjects underwent SDOCT imaging of the macula. An image segmentation technique was used to measure thickness of six retinal layers at 200 μm intervals. A mixed-effects model was used for multivariate analysis.
Results
By measuring total retinal thickness either at the central macular (2800 μm in diameter), the perifoveal region 1200-μm-width ring surrounding the central macula), or the overall macular area (5200 μm in diameter), there were no significant differences in the thickness between groups 1 and 2. On an image segmentation analysis, selective thinning of the inner plexiform+ganglion cell layers (P=0.021) was observed only in the perifoveal area of the patients in group 1 compared with that of group 2 by using the mixed-effects model analysis.
Conclusion
Our study results suggest that chronic exposure to hydroxychloroquine is associated with thinning of the perifoveal inner retinal layers, especially in the ganglion cell and inner plexiform layers, even in the absence of functional or structural clinical changes involving the photoreceptor or retinal pigment epithelial cell layers. This may be a contributing factor as the reason most patients who have early detectable signs of drug toxicity present with paracentral or pericentral scotomas.
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Acknowledgements
We thank Ms Patricia Grant-Jordan from the Department of Ophthalmology, University of Illinois for her technical support on a multifocal electroretinographic procedure. This study was supported by Foundation Fighting Blindness, Owings Mills, Maryland, and Grant Healthcare Foundation, Chicago, Illinois (GAF); NIH core Grant EY01792; an unrestricted departmental grant from Research to Prevent Blindness; NIH Grant EY014275, Department of Veterans’ Administration, and Research to Prevent Blindness Senior Scientific Investigator Award (MS).
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Pasadhika, S., Fishman, G., Choi, D. et al. Selective thinning of the perifoveal inner retina as an early sign of hydroxychloroquine retinal toxicity. Eye 24, 756–763 (2010). https://doi.org/10.1038/eye.2010.21
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DOI: https://doi.org/10.1038/eye.2010.21
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