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Outer retinal reflectivity on En‐face OCT as a new tool to detect early stage hydroxychloroquine maculopathy
Author(s) -
Viotte A.,
Bigan G.,
Flores M.,
Girard C.,
Delbosc B.,
Saleh M.
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.1755-3768.2016.0487
Subject(s) - maculopathy , ophthalmology , medicine , retinal , hydroxychloroquine , reflectivity , fundus (uterus) , macular degeneration , retinopathy , optics , covid-19 , physics , diabetes mellitus , endocrinology , disease , infectious disease (medical specialty)
Purpose Hydroxychloroquine (HCQ) maculopathy can cause irreversible vision loss. Alteration of the parafoveal photoreceptors has been reported to be one of the earliest histopathological sign. The relationship between the ellipsoid zone reflectivity and cone density was recently demonstrated. The main objective of the study was to measure the outer retinal reflectivity in patients taking a HCQ regimen without proven toxicity on routine screening tests. The second objective was to investigate the relationship between the reflectivity measured and the screening tests outcomes. Methods Consecutive patients visiting for HCQ toxicity screening in the Besançon University Hospital were included. All patients underwent a complete ophthalmic examination with a 10‐degrees automated perimetry (with measurement of the foveal threshold and the mean 2–5°), fundus autofluorescence, multifocal electroretinogram (with measurement of N1, P1 and N2 amplitudes in a 2–5° range) and spectral‐domain optical coherence tomography with en‐face reconstruction of the ellipsoid zone and the retinal pigment epithelium (with measurement of the absolute reflectivity expressed in greyscale in the 2–5° range). Results 76 eyes were studied (39 patients). None of them displayed a toxic maculopathy. The cumulative dose for HCQ ranged from 24 to 2,400 g (706 g ± 620). Bivariate analysis showed a decreased in ellipsoid reflectivity with escalating cumulative doses of HCQ (linear regression, p < 0.0001, r ²: 0.3). Reflectivity was also correlated with N1, P1 and N2 amplitudes (p < 0.05). Finally, reflectivity was statistically correlated with 5 degrees threshold perimetry (p < 0.005). Conclusions Parafoveolar ellipsoid reflectivity with en face OCT could be a rapid, repeatable and quantifiable biomarker allowing to detect the HCQ maculopathy earlier than any other screening method currently used.