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Electrophysiological and SD-OCT findings in patients receiving chloroquine therapy in relation to cumulative dosage and duration of treatment

Abstract

Purpose

Assessment of multifocal ERG (mfERG) changes in patients treated with chloroquine and their correlation with morphological abnormalities, detected by spectral-domain optical coherence tomography in relation to cumulative dosage.

Methods

Data from 37 eyes of 20 patients were retrospectively collected, and one randomly selected eye per patient was considered for statistical analysis. Eyes were divided into three groups according to mfERG and visual acuity findings: normal, early and advanced maculopathy. Functional measures of the first three mfERG rings were compared with retinal thickness measures of the corresponding OCT ETDRS circles. Data on cumulative dose and duration of therapy were also evaluated.

Results

The mean mfERG values progressively decreased according to the stage of the disease. In particular in the early maculopathy group, amplitudes were significantly reduced in all the three central rings. The mean ring ratio R1/R2 was abnormal only in the early maculopathy group. OCT thickness measures were significantly lower in all the three ETDRS circles in the advanced maculopathy group, and in the paracentral circle in the early maculopathy group. Considering all the eyes, there was a statistically significant correlation between functional and morphological values (p < 0.001). High chloroquine cumulative dosages were always associated with retinal toxic effects, whereas lower cumulative dosages generated different levels of toxicity.

Conclusions

This study shows a strong association between mfERG ring values and the corresponding OCT thickness measures; however, mfERG may enhance early detection of functional changes in patients treated with chloroquine, especially in ambiguous cases. At low chloroquine cumulative dosages, different subjects might have different susceptibilities to the drug.

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Author information

Correspondence to Federica Bertoli or Marko Hawlina.

Ethics declarations

Conflict of interest

Federica Bertoli, MD, was awarded a travel grant by the International Society for Clinical Electrophysiology of Vision to support her attendance at the 55th ISCEV international symposium, Miami, FL, October 2017, where she presented the preliminary results of this study. Maja Šuštar, PhD, declares that she has no conflict of interest. Martina Jarc Vidmar, MD, PhD, declares that she has no conflict of interest. Darko Perovšek, PhD, declares that he has no conflict of interest. Jelka Brecelj, PhD, declares that she has no conflict of interest. Špela Markelj, MD, declares that she has no conflict of interest. Polona Jaki Mekjavić, MD, PhD, declares that she has no conflict of interest. Daša Šuput, MD, declares that she has no conflict of interest. Matija Tomšič, MD, PhD, declares that he has no conflict of interest. Miriam Isola, PhD, declares that she has no conflict of interest. Claudio Battistella , MD, declares that he has no conflict of interest. Paolo Lanzetta, MD, serves as a consultant for the following companies: Bayer, CenterVue, Novartis Pharma AG. Marko Hawlina, MD, PhD, declares that he has no conflict of interest.

Human and animal rights

All procedures performed in studies involving human participants were in accordance with the ethical standards of the Ethics Committee of the Medical Faculty, University of Ljubljana, Slovenia, and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. No animals were used in this study.

Ethical approval

All procedures performed in this study were in accordance with the ethical standards of the Ethics Committee of the Medical Faculty, University of Ljubljana, Slovenia, and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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This study was performed at the Eye Hospital, University Medical Centre Ljubljana, Grablovičeva 46, 1000 Ljubljana, Slovenia.

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Bertoli, F., Šuštar, M., Jarc Vidmar, M. et al. Electrophysiological and SD-OCT findings in patients receiving chloroquine therapy in relation to cumulative dosage and duration of treatment. Doc Ophthalmol (2020). https://doi.org/10.1007/s10633-019-09744-0

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Keywords

  • Chloroquine
  • Maculopathy
  • Multifocal ERG
  • Optical coherence tomography
  • Toxicity
  • Cumulative dosage