Skip to main content
Top
Published in: International Ophthalmology 4/2018

01-08-2018 | Original Paper

Macular ganglion cell–inner plexiform layer thickness for detection of early retinal toxicity of hydroxychloroquine

Authors: Emrah Kan, Konuralp Yakar, Mehmet Derya Demirag, Mustafa Gok

Published in: International Ophthalmology | Issue 4/2018

Login to get access

Abstract

Purpose

This study evaluated the macular ganglion cell–inner plexiform layer (GC-IPL) thickness using spectral-domain (SD) optical coherence tomography (OCT) in patients with chronic exposure to hydroxychloroquine (HCQ).

Methods

A total of 90 patients (90 eyes) treated with HCQ for at least 5 years and normal controls were included in the study. A fundus examination, automated threshold perimetry, and GC-IPL thickness measurements using the Cirrus high-definition OCT ganglion cell analysis algorithm were performed in all patients treated with HCQ. Average, minimum, and sectorial macular GC-IPL thicknesses were compared between the patients and controls.

Results

There was no statistically significant difference in age or sex between the groups. The anterior segment and fundoscopy were normal in all patients and controls. Visual field (VF) testing was normal in all patients. The average, minimum, and sectorial macular GC-IPL thicknesses were significantly lower in patients than those in control subjects.

Conclusions

There was significant thinning of the macular GC-IPL in the absence of clinically evident HCQ-related retinopathy and VF abnormalities. Measurements of the macular GC-IPL thickness using SD-OCT may therefore be useful in the early diagnosis and in monitoring the progression of retinal changes in patients receiving long-term HCQ therapy.
Literature
1.
go back to reference Mavrikakis I, Sfikakis PP, Mavrikakis E, Rougas K, Nikolaou A, Kostopoulos C et al (2003) The incidence of irreversible retinal toxicity in patients treated with hydroxychloroquine: a reappraisal. Ophthalmology 110:1321–1326CrossRefPubMed Mavrikakis I, Sfikakis PP, Mavrikakis E, Rougas K, Nikolaou A, Kostopoulos C et al (2003) The incidence of irreversible retinal toxicity in patients treated with hydroxychloroquine: a reappraisal. Ophthalmology 110:1321–1326CrossRefPubMed
2.
go back to reference Bienfang D, Coblyn JS, Liang MH, Corzillius M (2000) Hydroxychloroquine retinopathy despite regular ophthalmologic evaluation: a consecutive series. J Rheumatol 27:2703–2706PubMed Bienfang D, Coblyn JS, Liang MH, Corzillius M (2000) Hydroxychloroquine retinopathy despite regular ophthalmologic evaluation: a consecutive series. J Rheumatol 27:2703–2706PubMed
3.
go back to reference Levy GD, Munz SJ, Paschal J, Cohen HB, Pince KJ, Peterson T (1997) Incidence of hydroxychloroquine retinopathy in 1207 patients in a large multicenter outpatient practice. Arthritis Rheum 40:1482–1486CrossRefPubMed Levy GD, Munz SJ, Paschal J, Cohen HB, Pince KJ, Peterson T (1997) Incidence of hydroxychloroquine retinopathy in 1207 patients in a large multicenter outpatient practice. Arthritis Rheum 40:1482–1486CrossRefPubMed
4.
go back to reference Tzekov R (2005) Ocular toxicity due to chloroquine and hydroxychloroquine: electrophysiological and visual function correlates. Doc Ophthalmol 110:111–120CrossRefPubMed Tzekov R (2005) Ocular toxicity due to chloroquine and hydroxychloroquine: electrophysiological and visual function correlates. Doc Ophthalmol 110:111–120CrossRefPubMed
5.
go back to reference Marmor MF, Carr RE, Easterbrook M, Farjo AA, Mieler WF (2002) Recommendations on screening for chloroquine and hydroxychloroquine retinopathy: a report by the American Academy of Ophthalmology. Ophthalmology 109:1377–1382CrossRefPubMed Marmor MF, Carr RE, Easterbrook M, Farjo AA, Mieler WF (2002) Recommendations on screening for chloroquine and hydroxychloroquine retinopathy: a report by the American Academy of Ophthalmology. Ophthalmology 109:1377–1382CrossRefPubMed
6.
go back to reference Easterbrook M (1999) Detection and prevention of maculopathy associated with antimalarial agents. Int Ophthalmol Clin 39:49–57CrossRefPubMed Easterbrook M (1999) Detection and prevention of maculopathy associated with antimalarial agents. Int Ophthalmol Clin 39:49–57CrossRefPubMed
7.
go back to reference Carr RE, Gouras P, Gunkel RD (1966) Chloroquine retinopathy: early detection by retinal threshold test. Arch Ophthalmol 75:171–178CrossRefPubMed Carr RE, Gouras P, Gunkel RD (1966) Chloroquine retinopathy: early detection by retinal threshold test. Arch Ophthalmol 75:171–178CrossRefPubMed
8.
go back to reference Rosenthal AR, Kolb H, Bergsma D, Huxsoll D, Hopkins JL (1978) Choroquine retinopathy in the rhesus monkey. Invest Ophthalmol Vis Sci 17:1158–1175PubMed Rosenthal AR, Kolb H, Bergsma D, Huxsoll D, Hopkins JL (1978) Choroquine retinopathy in the rhesus monkey. Invest Ophthalmol Vis Sci 17:1158–1175PubMed
9.
go back to reference Hallberg A, Naeser P, Andersson A (1990) Effects of long-term chloroquine exposure on the phospholipids metabolism in retina and pigment epithelium of the mouse. Acta Ophthalmol (Copenh) 68:125–130CrossRef Hallberg A, Naeser P, Andersson A (1990) Effects of long-term chloroquine exposure on the phospholipids metabolism in retina and pigment epithelium of the mouse. Acta Ophthalmol (Copenh) 68:125–130CrossRef
10.
go back to reference Easterbrook M (1992) Long-term course of antimalarial maculopathy after cessation of treatment. Can J Ophthalmol 27:237–239PubMed Easterbrook M (1992) Long-term course of antimalarial maculopathy after cessation of treatment. Can J Ophthalmol 27:237–239PubMed
11.
go back to reference Michaelides M, Stover NB, Francis PJ, Weleber RG (2011) Retinal toxicity associated with hydroxychloroquine and chloroquine: risk factors, screening, and progression despite cessation of therapy. Arch Ophthalmol 129:30–39CrossRefPubMed Michaelides M, Stover NB, Francis PJ, Weleber RG (2011) Retinal toxicity associated with hydroxychloroquine and chloroquine: risk factors, screening, and progression despite cessation of therapy. Arch Ophthalmol 129:30–39CrossRefPubMed
12.
go back to reference Mititelu M, Wong BJ, Brenner M, Bryar PJ, Jampol LM, Fawzi AA (2013) Progression of hydroxychloroquine toxic effects after drug therapy cessation: new evidence from multimodal imaging. JAMA Ophthalmol 131:1187–1197CrossRefPubMed Mititelu M, Wong BJ, Brenner M, Bryar PJ, Jampol LM, Fawzi AA (2013) Progression of hydroxychloroquine toxic effects after drug therapy cessation: new evidence from multimodal imaging. JAMA Ophthalmol 131:1187–1197CrossRefPubMed
13.
go back to reference Marmor MF, Kellner U, Lai TY, Lyons JS, Mieler WF (2011) Revised recommendations on screening for chloroquine and hydroxychloroquine retinopathy. Ophthalmology 118:415–422CrossRefPubMed Marmor MF, Kellner U, Lai TY, Lyons JS, Mieler WF (2011) Revised recommendations on screening for chloroquine and hydroxychloroquine retinopathy. Ophthalmology 118:415–422CrossRefPubMed
14.
go back to reference Gonasum LM, Potts AM (1974) In vitro inhibition of protein synthesis in the retinal pigment epithelium by chloroquine. Invest Ophthalmol Vis Sci 13:107–115 Gonasum LM, Potts AM (1974) In vitro inhibition of protein synthesis in the retinal pigment epithelium by chloroquine. Invest Ophthalmol Vis Sci 13:107–115
15.
go back to reference Geamănu Pancă A, Popa-Cherecheanu A, Marinescu B, Geamănu CD, Voinea LM (2014) Retinal toxicity associated with chronic exposure to hydroxychloroquine and its ocular screening. J Med Life 7:322–326PubMedPubMedCentral Geamănu Pancă A, Popa-Cherecheanu A, Marinescu B, Geamănu CD, Voinea LM (2014) Retinal toxicity associated with chronic exposure to hydroxychloroquine and its ocular screening. J Med Life 7:322–326PubMedPubMedCentral
16.
go back to reference Palma Sánchez D, Rubio Velazquez E, Soro Marín S, Reyes García R (2013) Retinal toxicity due to antimalarials: frequency and risk factors. Reumatol Clin 9:259–262CrossRefPubMed Palma Sánchez D, Rubio Velazquez E, Soro Marín S, Reyes García R (2013) Retinal toxicity due to antimalarials: frequency and risk factors. Reumatol Clin 9:259–262CrossRefPubMed
17.
go back to reference Wolfe F, Marmor MF (2010) Rates and predictors of hydroxychloroquine retinal toxicity in patients with rheumatoid arthritis and systemic lupus erythematosus. Arthritis Care Res (Hoboken) 62:775–784CrossRef Wolfe F, Marmor MF (2010) Rates and predictors of hydroxychloroquine retinal toxicity in patients with rheumatoid arthritis and systemic lupus erythematosus. Arthritis Care Res (Hoboken) 62:775–784CrossRef
18.
go back to reference Kim NR, Lee ES, Seong GJ, Kim JH, An HG, Kim CY (2010) Structure function relationship and diagnostic value of macular ganglion cell complex measurement using Fourier-domain OCT in glaucoma. Invest Ophthalmol Vis Sci 51:4646–4651CrossRefPubMed Kim NR, Lee ES, Seong GJ, Kim JH, An HG, Kim CY (2010) Structure function relationship and diagnostic value of macular ganglion cell complex measurement using Fourier-domain OCT in glaucoma. Invest Ophthalmol Vis Sci 51:4646–4651CrossRefPubMed
19.
go back to reference Cho JW, Sung KR, Lee S, Yun SC, Kang SY, Choi J et al (2010) Relationship between visual field sensitivity and macular ganglion cell complex thickness as measured by spectral-domain optical coherence tomography. Invest Ophthalmol Vis Sci 51:6401–6407CrossRefPubMed Cho JW, Sung KR, Lee S, Yun SC, Kang SY, Choi J et al (2010) Relationship between visual field sensitivity and macular ganglion cell complex thickness as measured by spectral-domain optical coherence tomography. Invest Ophthalmol Vis Sci 51:6401–6407CrossRefPubMed
20.
go back to reference Mwanza JC, Oakley JD, Budenz DL, Chang RT, Knight OJ, Feuer WJ (2011) Macular ganglion cell–inner plexiform layer: automated detection and thickness reproducibility with spectral domain–optical coherence tomography in glaucoma. Invest Ophthalmol Vis Sci 52:8323–8329CrossRefPubMedPubMedCentral Mwanza JC, Oakley JD, Budenz DL, Chang RT, Knight OJ, Feuer WJ (2011) Macular ganglion cell–inner plexiform layer: automated detection and thickness reproducibility with spectral domain–optical coherence tomography in glaucoma. Invest Ophthalmol Vis Sci 52:8323–8329CrossRefPubMedPubMedCentral
21.
go back to reference Girkin CA, McGwin G Jr, Sinai MJ, Sekhar GC, Fingeret M et al (2011) Variation in optic nerve and macular structure with age and race with spectraldomain optical coherence tomography. Ophthalmology 118:2403–2408CrossRefPubMed Girkin CA, McGwin G Jr, Sinai MJ, Sekhar GC, Fingeret M et al (2011) Variation in optic nerve and macular structure with age and race with spectraldomain optical coherence tomography. Ophthalmology 118:2403–2408CrossRefPubMed
22.
go back to reference Alasil T, Wang K, Keane PA, Lee H, Baniasadi N, de Boer JF et al (2013) Analysis of normal retinal nerve fiber layer thickness by age, sex, and race using spectral domain optical coherence tomography. J Glaucoma 22:532–541CrossRefPubMed Alasil T, Wang K, Keane PA, Lee H, Baniasadi N, de Boer JF et al (2013) Analysis of normal retinal nerve fiber layer thickness by age, sex, and race using spectral domain optical coherence tomography. J Glaucoma 22:532–541CrossRefPubMed
23.
go back to reference Koh VT, Tham YC, Cheung CY, Wong WL, Baskaran M, Saw SM, Wong TY, Aung T (2012) Determinants of ganglion cell–inner plexiform layer thickness measured by high-definition optical coherence tomography. Invest Ophthalmol Vis Sci 53:5853–5859CrossRefPubMed Koh VT, Tham YC, Cheung CY, Wong WL, Baskaran M, Saw SM, Wong TY, Aung T (2012) Determinants of ganglion cell–inner plexiform layer thickness measured by high-definition optical coherence tomography. Invest Ophthalmol Vis Sci 53:5853–5859CrossRefPubMed
24.
go back to reference Bonanomi MT, Dantas NC, Medeiros FA (2006) Retinal nerve fibre layer thickness measurements in patients using chloroquine. Clin Experiment Ophthalmol 34:130–136CrossRefPubMed Bonanomi MT, Dantas NC, Medeiros FA (2006) Retinal nerve fibre layer thickness measurements in patients using chloroquine. Clin Experiment Ophthalmol 34:130–136CrossRefPubMed
25.
go back to reference Pasadhika S, Fishman GA (2010) Effects of chronic exposure to hydroxychloroquine or chloroquine on inner retinal structures. Eye (Lond) 24:340–346CrossRef Pasadhika S, Fishman GA (2010) Effects of chronic exposure to hydroxychloroquine or chloroquine on inner retinal structures. Eye (Lond) 24:340–346CrossRef
26.
go back to reference Ulviye Y, Betul T, Nur TH, Selda C (2013) Spectral domain optical coherence tomography for early detection of retinal alterations in patients using hydroxychloroquine. Indian J Ophthalmol 61(4):168–171CrossRefPubMedPubMedCentral Ulviye Y, Betul T, Nur TH, Selda C (2013) Spectral domain optical coherence tomography for early detection of retinal alterations in patients using hydroxychloroquine. Indian J Ophthalmol 61(4):168–171CrossRefPubMedPubMedCentral
27.
go back to reference Lee MG, Kim SJ, Ham DI, Kang SW, Kee C, Lee J et al (2014) Macular retinal ganglion cell–inner plexiform layer thickness in patients on hydroxychloroquine therapy. Invest Ophthalmol Vis Sci 25(56):396–402 Lee MG, Kim SJ, Ham DI, Kang SW, Kee C, Lee J et al (2014) Macular retinal ganglion cell–inner plexiform layer thickness in patients on hydroxychloroquine therapy. Invest Ophthalmol Vis Sci 25(56):396–402
28.
go back to reference Pasadhika S, Fishman GA, Choi D, Shahidi M (2010) Selective thinning of the perifoveal inner retina as an early sign of hydroxychloroquine retinal toxicity. Eye (Lond) 245:756–762CrossRef Pasadhika S, Fishman GA, Choi D, Shahidi M (2010) Selective thinning of the perifoveal inner retina as an early sign of hydroxychloroquine retinal toxicity. Eye (Lond) 245:756–762CrossRef
29.
go back to reference Marmor MF, Melles RB (2014) Disparity between visual fields and optical coherence tomography in hydroxychloroquine retinopathy. Ophthalmology 121:1257–1262CrossRefPubMed Marmor MF, Melles RB (2014) Disparity between visual fields and optical coherence tomography in hydroxychloroquine retinopathy. Ophthalmology 121:1257–1262CrossRefPubMed
30.
go back to reference Uslu H, Gurler B, Yildirim A, Tatar MG, Aylin Kantarcı F, Goker H, Pehlevan HS, Colak HN (2016) Effect of hydroxychloroquine on the retinal layers: a quantitative evaluation with spectral-domain optical coherence tomography. J Ophthalmol 2016:8643174. doi:10.1155/2016/8643174 CrossRefPubMedPubMedCentral Uslu H, Gurler B, Yildirim A, Tatar MG, Aylin Kantarcı F, Goker H, Pehlevan HS, Colak HN (2016) Effect of hydroxychloroquine on the retinal layers: a quantitative evaluation with spectral-domain optical coherence tomography. J Ophthalmol 2016:8643174. doi:10.​1155/​2016/​8643174 CrossRefPubMedPubMedCentral
Metadata
Title
Macular ganglion cell–inner plexiform layer thickness for detection of early retinal toxicity of hydroxychloroquine
Authors
Emrah Kan
Konuralp Yakar
Mehmet Derya Demirag
Mustafa Gok
Publication date
01-08-2018
Publisher
Springer Netherlands
Published in
International Ophthalmology / Issue 4/2018
Print ISSN: 0165-5701
Electronic ISSN: 1573-2630
DOI
https://doi.org/10.1007/s10792-017-0635-y

Other articles of this Issue 4/2018

International Ophthalmology 4/2018 Go to the issue