Assessment of parafoveal cone density in patients taking hydroxychloroquine in the absence of clinically documented retinal toxicity

作者：Debellemaniere Guillaume; Flores Mathieu; Tumahai Perle; Meillat Mathieu; Garnier Melanie Bidaut; Delbosc Bernard; Saleh Maher^*

来源：Acta Ophthalmologica, 2015, 93(7): E534-E540.

DOI：10.1111/aos.12728

• cone density
• hydroxychloroquine toxicity
• retinal imaging
• screening

PurposeTo measure cone density in patients taking hydroxychloroquine (HCQ), with no clinical evidence of maculopathy.
MethodsPatients visiting for HCQ macular toxicity screening in the Besancon University Hospital Ophthalmology Department (France) were studied. They underwent routine examination including spectral-domain optical coherence tomography, fundus autofluorescence and multifocal electroretinogram to detect HCQ-induced retinal toxicity. Cone metrics (density, spacing and percentage of cones with six neighbours) were obtained using an adaptive optics camera (RTX1, Imagine Eyes, Orsay, France). The region of interest corresponded to a 0.3 degrees x0.3 degrees square placed nasally and temporally at 2 degrees of eccentricity from the fovea.
ResultsForty eyes of 23 patients were studied. The majority of the patients (21/23) were female. They were aged from 25 to 60years (mean ageSD: 40.1years +/- 10). The cumulative dose for HCQ ranged from 24 to 2160g (777 +/- 558g). None of them displayed HCQ toxicity on screening tests. Bivariate analysis showed moderate cone loss with escalating doses of HCQ (linear regression, r(2)=0.23, p=0.018). Cone spacing also increased with increasing cumulative dose (r(2)=0.17, p=0.008). Cone packing remained unchanged (p>0.05). Multivariate analysis showed that age and cumulative dose were additive and independent factors of cone dropout.
ConclusionsIn this pilot study, we observed moderate cone loss as HCQ cumulative doses increased. The early detection of parafoveal cone metric changes may represent the earliest sign of HCQ macular toxicity during screening.

• 出版日期2015-11