Korean J Ophthalmol.  2018 Dec;32(6):459-469. 10.3341/kjo.2018.0004.

Peripapillary Retinal Nerve Fiber Layer Thicknesses Did Not Change in Long-term Hydroxychloroquine Users

• Lee EJ
• Kim SJ
• Han JC
• Eo DR
• Lee MG
• Ham DI
• Kang SW
• Kee C
• Lee J
• Cha HS
• Koh EM

• KMID: 2427960
• DOI: http://doi.org/10.3341/kjo.2018.0004

Abstract

PURPOSE
To evaluate changes in the peripapillary retinal nerve fiber layer (RNFL) thicknesses using spectral-domain optical coherence tomography (SD-OCT) in hydroxychloroquine (HCQ) users.
METHODS
The medical records of HCQ users were retrospectively reviewed. In these HCQ users, an automated perimetry, fundus autofluorescence photography, and SD-OCT with peripapillary RNFL thickness measurements were performed. The peripapillary RNFL thicknesses were compared between the HCQ users and the control groups. The relationships between the RNFL thicknesses and the duration or cumulative dosage of HCQ use were analyzed.
RESULTS
This study included 77 HCQ users and 20 normal controls. The mean duration of HCQ usage was 63.6 ± 38.4 months, and the cumulative dose of HCQ was 528.1 ± 3.44 g. Six patients developed HCQ retinopathy. Global and six sectoral RNFL thicknesses of the HCQ users did not significantly decrease compared to those of the normal controls. No significant correlation was found between the RNFL thickness and the duration of use or cumulative dose. The eyes of those with HCQ retinopathy had temporal peripapillary RNFL thicknesses significantly greater than that of normal controls.
CONCLUSIONS
The peripapillary RNFL thicknesses did not change in the HCQ users and did not correlate with the duration of HCQ use or cumulative doses of HCQ. RNFL thickness is not a useful biomarker for the early detection of HCQ retinal toxicity.

Keyword

Hydroxychloroquine; Peripapillary retinal nerve fiber layer; Spectral-domain optical coherence tomography

MeSH Terms

Humans
Hydroxychloroquine*
Medical Records
Nerve Fibers*
Photography
Retinaldehyde*
Retrospective Studies
Tomography, Optical Coherence
Visual Field Tests
Hydroxychloroquine
Retinaldehyde

Figure

• 

  Fig. 1 Peripapillary retinal nerve fiber layer (RNFL) thicknesses in hydroxychloroquine (HCQ) users and normal controls. The relationship between RNFL thickness, duration of use, and cumulative doses are shown together. The distribution of global RNFL thicknesses is not significantly different from the normal controls in all HCQ users, and there was no definite relationship between cumulative doses (A) or duration of use (B). The result was consistent in the temporal (C,D) and nasal (E,F) sectors. Note: some eyes with HCQ retinopathy showed high RNFL thickness values. Red dots indicated patients with HCQ retinopathy, green dots indicated patients with HCQ users over 5 years and without HCQ retinopathy, and yellow dots indicated normal controls.

• 

  Fig. 2 Representative images of the right eye of a 33-year-old female diagnosed with rheumatoid arthritis. This patient had chronic exposure to a total of 786 g of hydroxychloroquine for 119 months. Her daily dosage per ideal body weight was 4.43 mg/kg. The best-corrected visual acuity was 20 / 20 in both eyes. The color fundus photograph (A) and the optical coherence tomography (B) shows severe hydroxychloroquine retinopathy with outer retinal collapse in the peripheral fovea. (C) Humphrey 10-2 visual field testing shows ring scotoma. (D) Despite collapsed outer retinal layer, retinal nerve fiber layer thickening was observed in the circular B-scan. (E) Spectralis spectral-domain optical coherence tomography measurements of the peripapillary retinal nerve fiber layer thickness showed no area of thinning.

• 

  Fig. 3 Six hydroxychloroquine retinopathy patients and their peripapillary retinal nerve fiber layer (RNFL) thickness profiles and ganglion cell-inner plexiform layer thicknesses. (A–C) Three patients with RNFL thickening showed more severe ganglion cell damage than (D–F) other three patients without RNFL thickening. OCT = optical coherence tomography; GC-IPL = ganglion cell-inner plexiform layer; TMP = temporal; SUP = superior; NAS = nasal; INF = inferior.

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