Eye and Ear Hospital International, Naccache, Lebanon.
Faculty of Medicine, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon.
BMC Ophthalmol. 2024 Sep 27;24(1):414. doi: 10.1186/s12886-024-03684-3.
Hydroxychloroquine (HCQ) is widely used to treat various autoimmune diseases but carries a risk of retinal toxicity, particularly with prolonged use. Despite advancements, uncertainty persists regarding optimal screening methods. Recent advances in OCT have enabled early detection of retinal damage, with studies suggesting that thinning of specific retinal layers may be an early indicator of toxicity. However, there is a gap in research on outer nuclear layer (ONL) thinning in HCQ users without apparent retinal toxicity. This information is crucial for improving screening and identifying the ONL as a reliable biomarker for screening. Therefore, this study aimed to investigate the association between HCQ intake and ONL damage in eyes without manifest retinal toxicity.
A case‒control study was conducted at the ophthalmology department of Eye and Ear Hospital International from July 2022 to June 2023. The study included 20 individuals on HCQ and 20 age-matched controls. The data were obtained through chart reviews, and participants underwent comprehensive ophthalmic assessments.
A total of 80 eyes were analyzed. Patients on HCQ exhibited significantly thinner perifoveal, parafoveal, and overall ONL compared to controls (P < .001, P < .012, and P < .004, respectively). Similarly, this association was found in the nasal, inferior, and temporal quadrants of both the inner (region 3: P < .01, region 4: P < .001, and region 5: P < .03) and outer zones (region 7: P < .04, region 8: P < .001, region 9: P < .02), most pronounced in the inferior regions. The cumulative dose was weakly associated with decreased ONL thickness only in the nasal quadrant of the inner zone (region 3: P < .047). Correlation analysis of the initial and most recent OCT scans in the same individuals revealed a weak association with ONL thinning in the central zone (region 1: P < .0048).
The thickness of the ONL can significantly decrease in patients taking HCQ, even in the absence of of manifest retinal toxicity. This study is the first to evaluate this association in eyes with negative screening and diagnostic tests for HCQ retinopathy. The findings suggest that ONL thickness could serve as an early diagnostic indicator for HCQ retinal toxicity.
羟氯喹（HCQ）广泛用于治疗各种自身免疫性疾病，但长期使用存在视网膜毒性风险。尽管有了进展，但对于最佳筛查方法仍存在不确定性。最近 OCT 的进步使视网膜损伤的早期检测成为可能，研究表明，特定视网膜层的变薄可能是毒性的早期指标。然而，在没有明显视网膜毒性的 HCQ 使用者中，关于外核层（ONL）变薄的研究仍存在空白。这些信息对于改进筛查和将 ONL 确定为可靠的筛查生物标志物至关重要。因此，本研究旨在探讨 HCQ 摄入与无明显视网膜毒性的眼睛中 ONL 损伤之间的关系。
本病例对照研究于 2022 年 7 月至 2023 年 6 月在 Eye and Ear Hospital International 的眼科进行。研究包括 20 名接受 HCQ 治疗的患者和 20 名年龄匹配的对照组。数据通过图表回顾获得，参与者接受了全面的眼科评估。
共分析了 80 只眼睛。与对照组相比，接受 HCQ 治疗的患者的周边、旁中心和整体 ONL 明显变薄（P<0.001、P<0.012 和 P<0.004，分别）。同样，在鼻侧、下侧和颞侧的内区（区域 3：P<0.01、区域 4：P<0.001 和区域 5：P<0.03）和外区（区域 7：P<0.04、区域 8：P<0.001、区域 9：P<0.02）也发现了这种关联，下侧区域最为明显。累积剂量仅与内区鼻侧的 ONL 厚度减少呈弱相关（区域 3：P<0.047）。对同一患者的初始和最近 OCT 扫描进行的相关分析显示，与中央区 ONL 变薄呈弱相关（区域 1：P<0.0048）。
即使在没有明显的 HCQ 视网膜毒性的情况下，接受 HCQ 治疗的患者的 ONL 厚度也会显著减少。本研究首次评估了在对 HCQ 视网膜病变进行阴性筛查和诊断性检查的眼睛中这种相关性。研究结果表明，ONL 厚度可能成为 HCQ 视网膜毒性的早期诊断指标。
