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. 2022 Jul;50(5):500-509.
doi: 10.1111/ceo.14090. Epub 2022 May 14.

Quantitative autofluorescence findings in patients undergoing hydroxychloroquine treatment

Salvatore Parrulli  1 , Mariano Cozzi  1 , Matteo Airaldi  1 , Francesco Romano  1 , Francesco Viola  2   3 , Piercarlo Sarzi-Puttini  4 , Giovanni Staurenghi  1 , Alessandro Invernizzi  1   5
Affiliations

Quantitative autofluorescence findings in patients undergoing hydroxychloroquine treatment

Salvatore Parrulli et al. Clin Exp Ophthalmol. 2022 Jul.

Abstract

Background: To measure quantitative autofluorescence (qAF) in patients under treatment with hydroxychloroquine (HCQ) and at risk of retinal toxicity but with no apparent signs of retinal toxicity and to compare it with that of untreated subjects.

Methods: Consecutive patients at risk for the development of HCQ retinal toxicity (duration of treatment >5 years or daily HCQ dose >5 mg/kg of actual body weight [ABW]) but no alterations on spectral domain-optical coherence tomography, short-wavelength autofluorescence and 10-2 visual field examination were recruited. Healthy subjects matched by age and sex were also enrolled in the study. All subjects underwent qAF measurements in one eye. Images were analysed using the conventional qAF grid by Delori calculating the qAF of eight sectors of the intermediate ring and the mean of those values (qAF8 ).

Results: Thirty-nine patients treated with HCQ (38 females, mean age 52.1 ± 8.6 years) and 39 untreated subjects (38 females, mean age 51.2 ± 8.6 years) were included. In both HCQ patients and untreated subjects, qAF8 was positively correlated with age (p = 0.004). Although HCQ patients showed a higher mean qAF8 compared with untreated subjects (294.7 ± 65.3 vs. 268.9 ± 57.5), the difference was not significant (p = 0.068). HCQ patients showed significantly higher mean qAF values in the inferior-temporal, inferior and inferior-nasal sectors of the intermediate ring of qAF grid compared with untreated subjects (all p < 0.05).

Conclusions: These results suggest a possible preclinical increase of qAF values in inferior parafoveal sectors probably induced by HCQ exposure.

Keywords: hydroxychloroquine; hydroxychloroquine retinopathy screening; multimodal imaging; quantitative autofluorescence.

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Conflict of interest statement

Salvatore Parrulli, no financial disclosures; Mariano Cozzi, Recipient: Bayer, Nidek, Zeiss; Matteo Airaldi, no financial disclosures; Francesco Romano, no financial disclosures; Francesco Viola, Novartis (C), Bayer (C), Roche (C); Piercarlo Sarzi‐Puttini, no financial disclosures; Giovanni Staurenghi, Heidelberg Engineering (C), QuantelMedical (C), Centervue (C), Carl Zeiss Meditec (C), Alcon (C), Allergan (C), Bayer (C), Boheringer (C), Genentech (C), GSK (C), Novartis (C), and Roche (C), Optos (F), Optovue (F) and Centervue (F); Alessandro Invernizzi, Novartis (C), Bayer (C).

Figures

FIGURE 1
FIGURE 1
Colour‐coded quantitative Autofluorescence (qAF) map of a study patient. A Delori pattern grid has been superimposed and the eight subfields necessary to generate the qAF8 value have been highlighted in yellow
FIGURE 2
FIGURE 2
Graphic representation of qAF8 and role of age and HCQ daily dose/ABW. As known qAF8 increases with age with a logarithmic behaviour. Higher HCQ daily dosages are more often located above the middle line, although a clear correlation was not confirmed by multivariate analysis
FIGURE 3
FIGURE 3
Visual representation of expected qAF values as influenced by age and HCQ daily dose/ABW, calculated for a treatment duration of 15 years. Expected values have been computed through GLMM regression (see methods section) and have been standardised for graphical purposes
FIGURE 4
FIGURE 4
Scatter plot representing qAF values of the superior sectors (y axis) and of the inferior sectors (x axis). The slope of the trend line for unexposed patients appears greater compared to HCQ patients. This may be due to higher qAF values in the inferior sectors compared to superior sectors for HCQ patients
See this image and copyright information in PMC

References

    1. Haładyj E, Sikora M, Felis‐Giemza A, Olesińska M. Antimalarials ‐ are they effective and safe in rheumatic diseases? Reumatologia. 2018;56(3):164‐173. - PMC - PubMed
    1. Alarcón GS, McGwin G, Bertoli AM, et al. Effect of hydroxychloroquine on the survival of patients with systemic lupus erythematosus: data from LUMINA, a multiethnic US cohort (LUMINA L). Ann Rheum Dis. 2007;66(9):1168‐1172. - PMC - PubMed
    1. Fernandez AP. Updated recommendations on the use of hydroxychloroquine in dermatologic practice. J Am Acad Dermatol. 2017;76(6):1176‐1182. - PubMed
    1. Yusuf IH, Sharma S, Luqmani R, Downes SM. Hydroxychloroquine retinopathy. Eye (Lond). 2017;31(6):828‐845. - PMC - PubMed
    1. Rosenthal AR, Kolb H, Bergsma D, Huxsoll D, Hopkins JL. Chloroquine retinopathy in the rhesus monkey. Invest Ophthalmol Vis Sci. 1978;17(12):1158‐1175. - PubMed