Spectral-domain optical coherence tomography and adaptive optics may detect hydroxychloroquine retinal toxicity before symptomatic vision loss.

Kimberly E Stepien, Dennis P Han, Jonathan Schell, Pooja Godara, Jungtae Rha, Joseph Carroll
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Abstract

Purpose: To describe spectral-domain optical coherence tomography (SD-OCT) and adaptive optics (AO) imaging in hydroxychloroquine retinal toxicity.

Methods: Two patients with long-term hydroxychloroquine use, subtle perifoveal ophthalmoscopic pigmentary changes, and bilateral perifoveal defects on automated Humphrey visual field (HVF) 10-2 perimetry were imaged using SD-OCT and AO.

Results: SD-OCT images demonstrated loss of photoreceptor inner segment/outer segment (IS/OS) junction and a downward "sink-hole" displacement of inner retinal structures in areas of hydroxychloroquine toxicity corresponding to HVF 10-2 defects and ophthalmoscopic clinical examination findings. SD-OCT irregularities in the IS/OS junction were also seen in areas not detected on HVF 10-2. AO images showed disruption of the cone photoreceptor mosaic in areas corresponding to HVF 10-2 defects and SD-OCT IS/OS junction abnormalities. Additionally, irregularities in the cone photoreceptor density and mosaic were seen in areas with normal HVF 10-2 and SD-OCT findings.

Conclusions: SD-OCT and AO detected abnormalities that correlate topographically with visual field loss from hydroxychloroquine toxicity as demonstrated by HVF 10-2 and may be useful in the detection of subclinical abnormalities that precede symptoms or objective visual field loss.

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光谱域光学相干断层扫描和自适应光学可以在症状性视力丧失之前检测羟氯喹视网膜毒性。
目的:描述羟基氯喹视网膜毒性的光谱域光学相干断层扫描(SD-OCT)和自适应光学成像(AO)。方法:采用SD-OCT和AO对2例长期使用羟氯奎的患者,在自动Humphrey视野(HVF) 10-2视野检查中出现轻微的角膜凹周色素改变和双侧角膜凹周缺损。结果:SD-OCT图像显示,羟氯喹毒性区域视网膜内段/外段(IS/OS)连接处缺失,视网膜内结构向下“凹陷”移位,与HVF 10-2缺陷和眼科临床检查结果相对应。在HVF 10-2未检测到的区域,也可以看到IS/OS交界处的SD-OCT异常。AO图像显示HVF 10-2缺陷和SD-OCT IS/OS连接异常对应区域的视锥光受体马赛克破坏。此外,在HVF - 10-2和SD-OCT表现正常的区域,可以看到锥体光感受器密度和马赛克的不规则性。结论:SD-OCT和AO检测到的异常与HVF 10-2证明的羟氯喹毒性引起的视野丧失在地形上相关,可能有助于检测症状前的亚临床异常或客观视野丧失。
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