Abstract
Purpose
To describe the findings and new interpretation methods of retinal thickness maps in the setting of hydroxychloroquine (HCQ) therapy.
Methods
A case series of 27 patients with a history of HCQ intake of more than 5 years and 21 normal subjects as the control group were studied. Patients were tested using swept-source optical coherence tomography (OCT). Custom-made 10 × 10 retinal thickness pixel maps of the 6 mm⨯6 mm area centered on the fovea were created for the full, inner, and outer retina of each eye and normal values obtained from the control group were used to calculate the statistical significance of each pixel and highlight suspicious pixels. A pixel was shown with light or dark gray color if its p value was ≤ 0.05 or ≤ 0.01, respectively. Cross-sectional OCT images and visual fields were examined as well and used to confirm the diagnosis of HCQ retinopathy.
Results
The pixel outer retinal thickness maps appeared accurate in detecting lesions even in eyes with unremarkable full retina thickness maps. The size and location of atrophic retinal defects were shown on pixel maps. Outer retinal thickness maps were able in differentiating outer retinal thinning from inner retinal thinning as the hallmark of HCQ retinopathy.
Conclusion
Outer retinal thickness pixel maps can be used for the screening of HCQ retinopathy.
Similar content being viewed by others
References
Ruiz-Irastorza G, Ramos-Casals M, Brito-Zeron P, Khamashta MA (2010) Clinical efficacy and side effects of antimalarials in systemic lupus erythematosus. Ann Rheum Dis 69:20–28. https://doi.org/10.1136/ard.2008.101766
Rainsford KD, Parke AL, Clifford-Rashotte M, Kean WF (2015) Therapy and pharmacological properties of hydroxychloroquine and chloroquine in treatment of systemic lupus erythematosus, rheumatoid arthritis and related diseases. Inflammopharmacology 23:231–269. https://doi.org/10.1007/s10787-015-0239-y
Kim KE, Ahn SJ, Woo SJ, Park KH, Lee BR, Lee Y, Sung Y (2021) Use of OCT retinal thickness deviation map for hydroxychloroquine retinopathy screening. Ophthalmology 128:110–119. https://doi.org/10.1016/j.ophtha.2020.06.021
Palazon-Cabanes A, Palazon-Cabanes B, Rubio-Velazquez E, Lopez-Bernal MD, Garcia-Medina JJ, Villegas-Perez MP (2020) Normative database for all retinal layer thicknesses using SD-OCT posterior pole algorithm and the effects of age, gender and axial length. J Clin Med 9:3317–3332. https://doi.org/10.3390/jcm9103317
Invernizzi A, Pellegrini M, Acquistapace A, Benatti E, Erba S, Cozzi M, Cigada M, Viola F, Gillies M, Staurenghi G (2018) Normative data for retinal-layer thickness maps generated by spectral-domain OCT in a white population. Ophthalmol Retina 2:808–815. https://doi.org/10.1016/j.oret.2017.12.012
Scuderi G, Fragiotta S, Scuderi L, Iodice CM, Perdicchi A (2020) Ganglion cell complex analysis in glaucoma patients: what can it tell us? Eye Brain 12:33–44. https://doi.org/10.2147/EB.S226319
Marmor MF, Kellner U, Lai TYY, Melles RB, Mieler WF (2016) Recommendations on screening for chloroquine and hydroxychloroquine retinopathy (2016 revision). Ophthalmology 123(6):1386–1394. https://doi.org/10.1016/j.ophtha.2016.01.058
De Sisternes L, Hu J, Rubin DL, Marmor MF (2016) Analysis of inner and outer retinal thickness in patients using hydroxychloroquine prior to development of retinopathy. JAMA Ophthalmol 134:511–519. https://doi.org/10.1001/jamaophthalmol.2016.0155
Casado A, López-de-Eguileta A, Soraya Fonseca S, Muñoz P, Demetrio R, Gordo-Vega MA, Andrea Cerveró A (2020) Outer nuclear layer damage for detection of early retinal toxicity of hydroxychloroquine. Biomedicines 8(3):54–63. https://doi.org/10.3390/biomedicines8030054
Garrity ST, Jung JY, Zambrowski O, Pichi F, Su D, Arya M, Waheed NK, Duker JS, Chetrit Y, Miserocchi E, Giuffrè C, Kaden TR, Querques G, Souied EH, Freund KB, Sarraf D (2019) Early hydroxychloroquine retinopathy: optical coherence tomography abnormalities preceding Humphrey visual field defects. Case Rep Br J Ophthalmol 103:1600–1604. https://doi.org/10.1136/bjophthalmol-2018-313350
Funding
The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.
Author information
Authors and Affiliations
Contributions
All authors contributed equally to the study conception and design, data collection and analysis, and writing of the manuscript.
Corresponding author
Ethics declarations
Competing interests
The authors declare no competing interests.
Conflict of interest
The authors have no relevant financial or non-financial interests to disclose.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Tarassoly, K., Miraftabi, A., Sedaghat, A. et al. Analysis of the outer retinal thickness pixel maps for the screening of hydroxychloroquine retinopathy. Int Ophthalmol 43, 1737–1743 (2023). https://doi.org/10.1007/s10792-022-02573-2
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10792-022-02573-2