Clinical Publications

TRITON

Macular Ganglion Cell Complex and Peripapillary Retinal Nerve Fiber Layer Thicknesses in Hydroxychloroquine Retinopathy

AUTHORS:

Kim KE, Kim YH, Kim J, Ahn SJ

PUBLICATION:

Am J Ophthalmol. 2023 Jan;245:70-80. Epub 2022 Aug 11. PMID: 35963445. DOI: 10.1016/j.ajo.2022.07.028

Study Purpose

To investigate the macular ganglion cell complex (GCC) and peripapillary retinal nerve fiber layer (RNFL) thickness in patients with hydroxychloroquine retinopathy in differing severity

Overview

Study Design

Cross-sectional, case-control comparison

# of Eyes/
Patients

• 131 eyes with hydroxychloroquine retinopathy • 132 matched controls • All Korean patients.

Study Device

DRI Triton SS-OCT (Topcon, Tokyo, Japan)
F-10 confocal scanning laser ophthalmoscope (Nidek)
Ultra-widefield FAF (Optos PLC).
Humphrey Field Analyzer II or III (Carl

Outcome Measures

• Macular GCC (macular RNFL, ganglion cell layer and inner plexiform layer) • Peripapillary RNFL (pRNFL) • 10-2 or 30-2 Humphrey standard

Results

Eyes with retinopathy presented with significantly thinner average GCC than those without retinopathy (P=0.009).
The average and inferior pRNFL thicknesses were significantly lower in eyes with retinopathy than those without (P<0.001).

IMOvifa reduced measurement time by

39%

FIGURE

FIGURE.

Photographic examples showing discrepancy in outer retinal damage on (A) fundus autofluorescence and (B) optical coherence tomography (OCT) B-scans with (C) inner retinal thinning on a thickness deviation map and (D) visual field defects. Adapted from Am J Ophthalmol. 2023 Jan;245:70-80. Epub 2022 Aug 11. PMID: 35963445. DOI: 10.1016/j.ajo.2022.07.028.

Conclusions

• Inner retinal changes might not be clinically significant at earlier stages, regardless of drug duration or cumulative dose. • Careful investigation and monitoring of inner retinal changes in eyes with advanced hydroxychloroquine retinopathy should be performed, as this may contribute to structural degeneration in the whole retina and functional deterioration that cannot be accounted for by outer retinal damage only.