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Retinal functional changes measured by frequency-doubling technology in patients treated with hydroxychloroquine

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Abstract

Background

Antimalarial drugs such as chloroquine (CQ) and hydroxychloroquine (HCQ) are mainly used in the treatment of rheumatologic diseases, and their use may be associated with irreversible retinal toxicity. Previous studies indicate early paracentral visual field loss (Humphrey 10-2) in patients taking HCQ". These paracentral defects appear before changes in other clinical parameters as visual acuity and fundoscopy. The mechanism of CQ toxicity remains unclear. It was reported that toxic doses of CQ administered for as long as 4.5 years to Rhesus monkeys caused an initial dramatic effect on ganglion cells, followed later by photoreceptors and RPE degeneration. The purpose of this study is to explore early retinal functional changes measured by frequency-doubling technology (FDT) in patients treated with hydroxychloroquine (HCQ).

Methods

Forty-eight eyes of 48 subjects treated with hydroxychloroquine (HCQ), with no signs of retinal toxicity, and 36 eyes of 36 age and sex-matched healthy subjects were enrolled in this cross-sectional, prospective, observational, case control study. Functional testing included frequency-doubling Humphrey-matrix perimetry (FDP), white-on-white Humphrey visual field perimetry (HFA), using the 24-2 and 10-2 threshold programs, multifocal electroretinogram (mfERG, Veris 4.9) and low contrast sensitivity (CS) measurement.

Results

FDP mean deviation (MD) was found to be significantly reduced in HCQ-treated patients compared to controls both in the 24-2 (−1.38 ± 2.41 dB vs 0.21 ± 1.83dB, p < 0.01) and in the 10-2 program (−0.97 ±2.88 dB vs 0.15 ± 1.72dB, p < 0.01). FDP pattern standard deviation (PSD) was found to be significantly worse in HCQ-treated patients compared to controls both in the 24-2 (2.70 ± 0.65 dB vs 2.41 ± 0.31 dB, p < 0.01 and in the 10-2 program (2.86 ± 0.48 dB vs 2.48 ±0.39 dB, p < 0.01). HFA PSD and CS was also significantly reduced in HCQ patients, while response amplitude densities (RAD) were similar between patients and controls. A statistically significant difference in the ratio of the 5°–10° RAD and the 0°–2.5° RAD (0.31 ± 0.08 vs 0.36 ± 0.07 respectively, p < 0.05) was found between groups.

Conclusion

Frequency doubling perimetry could be useful to detect early retinal impairment in patients treated with hydroxychloroquine.

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Authors and Affiliations

  1. Fondazione G.B. Bietti for Study and Research in Ophthalmology, IRCCS, Via Livenza 3, Rome, 00198, , Italy

    Lucia Tanga, Marco Centofanti, Francesco Oddone, Mariacristina Parravano, Vincenzo Parisi, Lucia Ziccardi & Gianluca Manni

  2. UOSD Glaucoma, University of Tor Vergata, Viale Oxford 81, Rome, 00133, , Italy

    Marco Centofanti & Gianluca Manni

  3. U.O.C. Reumatologia, Policlinico Tor Vergata, Viale Oxford 81,, 00133, Rome, Italy

    Barbara Kroegler & Roberto Perricone

Authors
  1. Lucia Tanga
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  2. Marco Centofanti
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  3. Francesco Oddone
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  4. Mariacristina Parravano
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  5. Vincenzo Parisi
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  6. Lucia Ziccardi
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  7. Barbara Kroegler
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  8. Roberto Perricone
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  9. Gianluca Manni
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Corresponding author

Correspondence to Lucia Tanga.

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The authors have no financial relationships.

The authors have full control of all primary data, and agree to allow Graefe’s Archives for Clinical and Experimantal Ophthalmology to review their data.

The authors have the full controls off all primary data and are agree to allow Graefe's Archives for clinical and Experimental Ophthamology to review our data.

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Tanga, L., Centofanti, M., Oddone, F. et al. Retinal functional changes measured by frequency-doubling technology in patients treated with hydroxychloroquine. Graefes Arch Clin Exp Ophthalmol 249, 715–721 (2011). https://doi.org/10.1007/s00417-010-1612-6

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  • DOI: https://doi.org/10.1007/s00417-010-1612-6

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