Premium
Early hydroxychloroquine retinal toxicity enhanced by multifocal electroretinogram and laser flare‐cell meter
Author(s) -
Cellini M.,
Sebastiani S.,
Campos E.
Publication year - 2016
Publication title -
acta ophthalmologica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.534
H-Index - 87
eISSN - 1755-3768
pISSN - 1755-375X
DOI - 10.1111/j.1755-3768.2016.0312
Subject(s) - hydroxychloroquine , medicine , toxicity , retinal , ophthalmology , rheumatoid arthritis , flare , electroretinography , mann–whitney u test , covid-19 , physics , disease , astrophysics , infectious disease (medical specialty)
Purpose The aim of this study is the evaluation of the multifocal electroretinogram (mfERG) and the laser flare‐cell meter methodology (LFM) in early detection of hydroxychloroquine (HCQ) retinal toxicity. Methods We enrolled 10 patients mean age 64.8 years with rheumatoid arthritis in therapy with hydroxychloroquine (400 mg/day) and cumulative dose (CD) of 625.6 ± 167.44‐g with no signs of retinal toxicity. As control group we recruited 10 health subjects mean age 61.3 years. MfERG (Retimax Plus, CSO, Florence, Italy) and LFM (FM‐500, Kowa, Tokio, Japan) were performed in all patients and controls. The Wilcoxon signed‐rank test and Spearman's correlation test was performed considering p < 0.05 as positive. Results Patients treated with HCQ showed compared to controls a significant amplitude reduction 0.518 ± 0.348 μ V vs. 0.745 ± 0.337 μ V (p = 0.035) with equally significant increase in latency 38.611 ± 2.857 ms vs. 36.334 ± 2.212 ms (p = 0.024) P1 wave in ring 2 of mfERG. The alteration of dependent values of mfERG correlated to the HCQ‐CD. To evaluate the behavior of the flare we divided the patients into two groups according to the CD: a group with CD > 500‐g and one with CD < 500‐g. The CD Group > 500‐g had a significant increase in flare values than the CD group < 500‐g: 14.4 ± 6.266 pg/ms vs. 8.1 ± 2.828 pg/ms (p = 0.008). The increase in the flare on the CD group>500 g was found to be related to the drug CD (r = 0.899; p = 0.001). Conclusions We found that mfERG P1 wave implicit time in ring 2 and the flare is the more sensitive test for demonstrating retinal dysfunction from HCQ toxicity in the setting of a normal fundus with a normal authomated visual field 10.2 and normal visual acuity. The increase in the flare would indicate not only a damage to the iris and cliary body pigmented cells but also an enzyme‐based breakdown of the blood retinal barrier directly caused by HCQ.