1
|
Li H, Zhang J, Yin X, Xiang Z, Qiu W, Huang AM, Wang L, Lv Q, Liu Z. Inter-eye asymmetry of microvascular density in patients on hydroxychloroquine therapy by optical coherence tomography angiography. Microvasc Res 2024; 157:104747. [PMID: 39288847 DOI: 10.1016/j.mvr.2024.104747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2024] [Revised: 08/26/2024] [Accepted: 09/12/2024] [Indexed: 09/19/2024]
Abstract
AIMS To explore the inter-eye retinal microvascular density asymmetry of patients on hydroxychloroquine (HCQ) therapy through optical coherence tomography angiography (OCTA). METHODS 40 subjects were enrolled in this cross-sectional study, including 20 systemic lupus erythematasus patients currently treated with HCQ (40 eyes) and 20 age- and sex-matched normal controls (NCs, 40 eyes). OCTA images were obtained to measure macular and peripapillary mircrovasculatures and microstructures, including vessel density, retinal nerver fiber layer thickness, and peripapillary ganglion cell-inner plexiform layer thickness. The absolute values of the difference between right and left eyes were taken as a measure of inter-eye asymmetry. RESULTS Macular whole image vessel density (wiVD-M) and perifoveal vessel density (pfVD) of superficial capillary plexus (SCP) were notably reduced in both the right and left eyes of the HCQ treatment group compared with NCs. Specifically, SLE patients treated with HCQ have higher inter-eye asymmetry of wiVD-M of SCP (2.28 ± 1.03 vs 1.27 ± 0.79, p < 0.01) and pfVD of SCP (2.55 ± 1.26 vs 1.78 ± 1.06, p = 0.04) compared with NCs. There were no significant differences in inter-eye asymmetry of structure parameters. Inter-eye asymmetry of wiVD-M of SCP (AUC = 0.80, p < 0.01) and pfVD of SCP (AUC = 0.71, p = 0.02) exhibited greater discrimination power. CONCLUSION SLE Patients treated with HCQ exhibited a notably higher inter-eye vessel density asymmetry compared to that of NCs. Thus, inter-eye vessel density asymmetry could be used to screen for HCQ retinal toxicity.
Collapse
Affiliation(s)
- Huangdong Li
- Ophthalmic Center, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou 510260, China
| | - Jingyu Zhang
- Ophthalmic Center, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou 510260, China
| | - Xi Yin
- Ophthalmic Center, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou 510260, China
| | - Zheng Xiang
- Ophthalmic Center, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou 510260, China
| | - Wangjian Qiu
- Ophthalmic Center, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou 510260, China; Shenzhen Songgang People's Hospital of Bao'an District, Shenzhen, Guangdong 518100, China
| | - Amy Michelle Huang
- Department of Ophthalmology, University of Colorado, Aurora, CO 80045, United States
| | - Li Wang
- Ophthalmic Center, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou 510260, China
| | - Quan Lv
- Department of Ophthalmology, Anxi County Hospital, Quanzhou, Fujian 362400, China.
| | - Zhiping Liu
- Ophthalmic Center, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou 510260, China.
| |
Collapse
|
2
|
Meng L, Wang Y, Yang Z, Lin S, Wang Y, Chen H, Zhao X, Chen Y. Ocular fundus changes and association with systemic conditions in systemic lupus erythematosus. Front Immunol 2024; 15:1395609. [PMID: 39091490 PMCID: PMC11291259 DOI: 10.3389/fimmu.2024.1395609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 06/26/2024] [Indexed: 08/04/2024] Open
Abstract
Systemic lupus erythematosus (SLE) is an autoimmune disease that affects multiple organs and systems. Ocular involvement is estimated to manifest in one-third of individuals with SLE, of which lupus retinopathy and choroidopathy represent the severe subtype accompanied by vision impairment. Advancements in multimodal ophthalmic imaging have allowed ophthalmologists to reveal subclinical microvascular and structural changes in fundus of patients with SLE without ocular manifestations. Both ocular manifestations and subclinical fundus damage have been shown to correlate with SLE disease activity and, in some patients, even precede other systemic injuries as the first presentation of SLE. Moreover, ocular fundus might serve as a window into the state of systemic vasculitis in patients with SLE. Given the similarities of the anatomy, physiological and pathological processes shared among ocular fundus, and other vital organ damage in SLE, such as kidney and brain, it is assumed that ocular fundus involvement has implications in the diagnosis and evaluation of other systemic impairments. Therefore, evaluating the fundus characteristics of patients with SLE not only contributes to the early diagnosis and intervention of potential vision damage, but also holds considerate significance for the evaluation of SLE vasculitis state and prediction of other systemic injuries.
Collapse
Affiliation(s)
- Lihui Meng
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
- Key Lab of Ocular Fundus Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | - Yinhan Wang
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
- Key Lab of Ocular Fundus Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | - Zhikun Yang
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
- Key Lab of Ocular Fundus Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | - Shiqun Lin
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
- Key Lab of Ocular Fundus Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | - Yuelin Wang
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
- Key Lab of Ocular Fundus Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | - Huan Chen
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
- Key Lab of Ocular Fundus Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | - Xinyu Zhao
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
- Key Lab of Ocular Fundus Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | - Youxin Chen
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
- Key Lab of Ocular Fundus Diseases, Chinese Academy of Medical Sciences, Beijing, China
| |
Collapse
|
3
|
Araújo O, Casaroli-Marano RP, Hernández-Rodríguez J, Figueras-Roca M, Budi V, Morató M, Hernández-Negrín H, Ríos J, Adan A, Espinosa G, Pelegrín L, Cervera R. New proposal for a multimodal imaging approach for the subclinical detection of hydroxychloroquine-induced retinal toxicity in patients with systemic lupus erythematosus. BMJ Open Ophthalmol 2024; 9:e001608. [PMID: 38499344 PMCID: PMC10953034 DOI: 10.1136/bmjophth-2023-001608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 02/14/2024] [Indexed: 03/20/2024] Open
Abstract
OBJECTIVE To compare multimodal structural and functional diagnostic methods in patients with systemic lupus erythematosus (SLE) treated with hydroxychloroquine, to identify the best complementary approach for detecting subclinical retinal toxicity. METHODS A cross-sectional, unicentric study was conducted on patients with SLE treated with hydroxychloroquine. Each patient underwent a comprehensive ophthalmic evaluation, comprising structural tests (spectral-domain optical coherence tomography (SD-OCT), en face OCT, en face OCT angiography (OCTA), fundus autofluorescence (FAF)) and functional tests (automated perimetry for visual field (VF) testing, multifocal electroretinography (mfERG)). A diagnosis of macular toxicity required the presence of abnormalities in at least one structural and functional test. The Kappa Concordance Index was used to assess the concordance among the different tests in detecting potential macular toxicity-associated alterations. RESULTS Sixty-six patients with SLE (132 eyes) were consecutively enrolled. Four (6.1%) patients developed subclinical hydroxychloroquine-induced retinal toxicity without visual acuity impairment. The proportion of abnormal results was 24% for both en face OCT and en face OCTA. Regarding functional analysis, VF was less specific than mfERG in detecting subclinical retinal toxicity (VF specificity 47.5%). En face OCT and en face OCTA structural findings showed better concordance, with a kappa index >0.8, and both identified the same cases of toxicity as FAF. CONCLUSION Although structural OCT and VF are frequently used to screen for hydroxychloroquine-induced retinal toxicity, our findings suggest that a combination of mfERG, en face OCT and en face OCTA could improve the diagnostic accuracy for subclinical retinal damage. This study emphasises the importance of a multimodal imaging strategy to promptly detect signs of hydroxychloroquine-induced retinal toxicity.
Collapse
Affiliation(s)
- Olga Araújo
- Department of Autoimmune Diseases, Reference Centre for Systemic Autoimmune Diseases, Vasculitis and Autoinflammatory Diseases (UEC/CSUR) of the Catalan and Spanish Health Systems. Member of ERN-ReCONNET/RITA. Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Catalonia, Spain
| | - Ricardo P Casaroli-Marano
- Department of Ophthalmology, Hospital Clinic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Catalonia, Spain
| | - José Hernández-Rodríguez
- Department of Autoimmune Diseases, Reference Centre for Systemic Autoimmune Diseases, Vasculitis and Autoinflammatory Diseases (UEC/CSUR) of the Catalan and Spanish Health Systems. Member of ERN-ReCONNET/RITA. Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Catalonia, Spain
| | - Marc Figueras-Roca
- Department of Ophthalmology, Hospital Clinic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Catalonia, Spain
| | - Vanesa Budi
- Department of Ophthalmology, Hospital Clinic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Catalonia, Spain
| | - Montse Morató
- Department of Ophthalmology, Hospital Clinic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Catalonia, Spain
| | - Halbert Hernández-Negrín
- Department of Autoimmune Diseases, Reference Centre for Systemic Autoimmune Diseases, Vasculitis and Autoinflammatory Diseases (UEC/CSUR) of the Catalan and Spanish Health Systems. Member of ERN-ReCONNET/RITA. Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Catalonia, Spain
| | - José Ríos
- Department of Medical Statistics Platform, Hospital Clínic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Catalonia, Spain
| | - Alfredo Adan
- Department of Ophthalmology, Hospital Clinic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Catalonia, Spain
| | - Gerard Espinosa
- Department of Autoimmune Diseases, Reference Centre for Systemic Autoimmune Diseases, Vasculitis and Autoinflammatory Diseases (UEC/CSUR) of the Catalan and Spanish Health Systems. Member of ERN-ReCONNET/RITA. Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Catalonia, Spain
| | - Laura Pelegrín
- Department of Ophthalmology, Hospital Clinic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Catalonia, Spain
| | - Ricard Cervera
- Department of Autoimmune Diseases, Reference Centre for Systemic Autoimmune Diseases, Vasculitis and Autoinflammatory Diseases (UEC/CSUR) of the Catalan and Spanish Health Systems. Member of ERN-ReCONNET/RITA. Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Catalonia, Spain
| |
Collapse
|
4
|
Centner A, Centner DJ. A Case of Hydroxychloroquine Toxicity as Evidenced by Visual Field Changes. Cureus 2024; 16:e53500. [PMID: 38440016 PMCID: PMC10911169 DOI: 10.7759/cureus.53500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2024] [Indexed: 03/06/2024] Open
Abstract
Hydroxychloroquine sulfate (Plaquenil®) is a disease-modifying anti-rheumatic drug (DMARD) utilized in the management of autoimmune diseases. While its immunomodulatory actions offer therapeutic benefits, a rare complication, hydroxychloroquine-induced retinal toxicity, poses a significant concern. We present the case of an 83-year-old patient with cutaneous lupus undergoing periodic hydroxychloroquine screening for eight years. Visual field changes consistent with retinal toxicity were observed. Chart review revealed subtle visual field depression two years prior. This highlights the importance of vigilance toward unexplained visual changes and subtle changes on ophthalmologic examination in hydroxychloroquine-treated patients. Our findings underscore the necessity of baseline and periodic ophthalmologic examinations with particular attention paid to visual field depression or deficit that might occur without macular changes. Additionally, we address the choice between red and white visual field testing. This case contributes to the understanding of hydroxychloroquine-induced retinal toxicity, emphasizing the importance of comprehensive ophthalmologic surveillance in long-term users.
Collapse
Affiliation(s)
- Aliya Centner
- Medicine, University of Central Florida College of Medicine, Orlando, USA
| | | |
Collapse
|
5
|
Geevarghese A, Kaiser A, Patel S, Saxena A, Belmont MH, Modi YS. Hydroxychloroquine Screening Guidelines: Best Evidence, Controversies, and Future Areas of Research. Int Ophthalmol Clin 2024; 64:195-207. [PMID: 38146891 DOI: 10.1097/iio.0000000000000508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2023]
|
6
|
Libman I, Bingley PJ, Becker D, Buckner JH, DiMeglio LA, Gitelman SE, Greenbaum C, Haller MJ, Ismail HM, Krischer J, Moore WV, Moran A, Muir AB, Raman V, Steck AK, Toledo FG, Wentworth J, Wherrett D, White P, You L, Herold KC. Hydroxychloroquine in Stage 1 Type 1 Diabetes. Diabetes Care 2023; 46:2035-2043. [PMID: 37708415 PMCID: PMC10620539 DOI: 10.2337/dc23-1096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 08/21/2023] [Indexed: 09/16/2023]
Abstract
OBJECTIVE Innate immune responses may be involved in the earliest phases of type 1 diabetes (T1D). RESEARCH DESIGN AND METHODS To test whether blocking innate immaune cells modulated progression of the disease, we randomly assigned 273 individuals with stage 1 T1D to treatment with hydroxychloroquine (n = 183; 5 mg/kg per day to a maximum of 400 mg) or placebo (n = 90) and assessed whether hydroxychloroquine treatment delayed or prevented progression to stage 2 T1D (i.e., two or more islet autoantibodies with abnormal glucose tolerance). RESULTS After a median follow-up of 23.3 months, the trial was stopped prematurely by the data safety monitoring board because of futility. There were no safety concerns in the hydroxychloroquine arm, including in annual ophthalmologic examinations. Preplanned secondary analyses showed a transient decrease in the glucose average area under the curve to oral glucose in the hydroxychloroquine-treated arm at month 6 and reduced titers of anti-GAD and anti-insulin autoantibodies and acquisition of positive autoantibodies in the hydroxychloroquine arm (P = 0.032). CONCLUSIONS We conclude that hydroxychloroquine does not delay progression to stage 2 T1D in individuals with stage 1 disease. Drug treatment reduces the acquisition of additional autoantibodies and the titers of autoantibodies to GAD and insulin.
Collapse
Affiliation(s)
- Ingrid Libman
- Department of Pediatrics, University of Pittsburgh, Pittsburgh, PA
| | - Polly J. Bingley
- School of Clinical Sciences, University of Bristol, Bristol, U.K
| | - Dorothy Becker
- Department of Pediatrics, University of Pittsburgh, Pittsburgh, PA
| | - Jane H. Buckner
- Center for Translational immunology, Benaroya Research Institute, Seattle, WA
| | | | - Stephen E. Gitelman
- Department of Pediatrics, University of California at San Francisco, San Francisco, CA
| | - Carla Greenbaum
- Center for Interventional Immunology, Benaroya Research Institute, Seattle, WA
| | | | - Heba M. Ismail
- Department of Pediatrics, Indiana University, Indianapolis, IN
| | - Jeffrey Krischer
- Departments of Pediatrics and Internal Medicine, Health Informatics Institute, University of South Florida, Tampa, FL
| | | | | | | | - Vana Raman
- Department of Pediatrics, University of Utah, Salt Lake City, UT
| | - Andrea K. Steck
- Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Frederico G.S. Toledo
- Division of Endocrinology and Metabolism, Department of Medicine, University of Pittsburgh, Pittsburgh, PA
| | | | - Diane Wherrett
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Perrin White
- Department of Pediatrics, University of Texas Southwestern, Dallas, TX
| | - Lu You
- Departments of Pediatrics and Internal Medicine, Health Informatics Institute, University of South Florida, Tampa, FL
| | - Kevan C. Herold
- Departments of Immunobiology and Internal Medicine, Yale University, New Haven, CT
| |
Collapse
|