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Early morpho-functional changes in patients treated with hydroxychloroquine: a prospective cohort study

  • Medical Ophthalmology
  • Published:
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Abstract

Purpose

We aimed to find earlier morphological and functional alterations in the retinas of patients treated with hydroxychloroquine (HCQ). This was a prospective cohort study.

Methods

We examined 33 patients (mean age, 57.14 [SD, 11.02] years) who were affected by various types of rheumatic diseases. The mean treatment period was 124.7 [SD, 99.4] months, and the mean total drug intake was 5.41 [SD, 3.34] g daily at baseline. The control group consisted of 28 subjects with a mean age of 61.25 [SD, 2.16 years]. The set of tests encompassed best-corrected visual acuity (BCVA), a multifocal electroretinogram (mfERG), spectral-domain optical coherence tomography (SD-OCT), fundus auto fluorescence (FAF), the 10-2 automated visual field (VF) test (10-2 VF), and frequency-doubling technology (FDT).

Results

The mfERG P1 wave density amplitudes decreased in all the rings, from 31.10 to 28.02 (p = 0.008) in the first ring, and from 18.29 to 16.55 [p < 0.001], from 12.050 to 10.91 [p = 0.002], from 9.53 to 8.69 [p = 0.003], and from 8.25 to 7.48 [p = 0.001] nanovolts/degree2 in rings 2, 3, 4, and 5, respectively. A significant reduction was found also in the N1 wave in the second ring. The SD-OCT retinal thickness measurement revealed significant thinning in five sectors, including the outer and inner nasal sectors, the outer and inner temporal sectors, and the inner superior sector. The 10-2 VF mean deviation paradoxically improved, while minimal FAF alterations in the retinal pigment epithelium were found in eight eyes.

Conclusions

mfERGs and SD-OCT were altered in our patients before significant retinal changes occurred.

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Abbreviations

CQ HCQ:

Chloroquine and hydroxychloroquine

mfERG:

Multifocal electroretinogram

SD-OCT:

Spectral-domain optical coherence tomography

FAF:

Fundus autofluorescence

FDT:

Frequency-doubling technology

10-2 VF:

Visual field

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Authors and Affiliations

  1. Ophthalmic Clinic, San Matteo Hospital, viale Golgi 19, 27100, Pavia, Italy

    Giulio Ruberto, Carlo Bruttini, Alessandro Bianchi & Giovanni Milano

  2. Biometric Service, San Matteo Hospital, Pavia, Italy

    Carmine Tinelli

  3. Rheumatology Clinic, San Matteo Hospital, Pavia, Italy

    Lorenzo Cavagna

Authors
  1. Giulio Ruberto
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  2. Carlo Bruttini
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  3. Carmine Tinelli
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  4. Lorenzo Cavagna
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  5. Alessandro Bianchi
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  6. Giovanni Milano
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Corresponding author

Correspondence to Giulio Ruberto.

Ethics declarations

The research adhered to the tenets of the Declaration of Helsinki and informed consent was obtained from all patients. Each patient signed an informed consent approved by the ethical committee of our institution.

Conflict of interest

The authors declare that they have no conflict of interest.

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Ruberto, G., Bruttini, C., Tinelli, C. et al. Early morpho-functional changes in patients treated with hydroxychloroquine: a prospective cohort study. Graefes Arch Clin Exp Ophthalmol 256, 2201–2210 (2018). https://doi.org/10.1007/s00417-018-4103-9

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  • DOI: https://doi.org/10.1007/s00417-018-4103-9

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