Bull’s Eye Maculopathy in Near-Infrared Reflectance as An Early Sign of Hydroxychloroquine Toxicity
Hydroxychloroquine (HCQ) ocular toxicity is rare but severe, and progression can occur even after termination of therapy. Case reports have suggested that a bull’s eye maculopathy detected by near-infrared reflectance (NIR) may indicate early HCQ toxicity. This retrospective cross-sectional study ev...
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| Format: | Article |
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MDPI AG
2023-01-01
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| Series: | Diagnostics |
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| Online Access: | https://www.mdpi.com/2075-4418/13/3/445 |
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| author | Miguel Santos Inês Leal Tiago Morais Sarmento Sofia Sousa Mano Patrícia José Sara Vaz-Pereira |
| author_facet | Miguel Santos Inês Leal Tiago Morais Sarmento Sofia Sousa Mano Patrícia José Sara Vaz-Pereira |
| author_sort | Miguel Santos |
| collection | DOAJ |
| description | Hydroxychloroquine (HCQ) ocular toxicity is rare but severe, and progression can occur even after termination of therapy. Case reports have suggested that a bull’s eye maculopathy detected by near-infrared reflectance (NIR) may indicate early HCQ toxicity. This retrospective cross-sectional study evaluated patients treated with HCQ who underwent routine screening with optical coherence tomography (OCT), fundus autofluorescence (FAF) and 10-2 perimetry. NIR images captured alongside OCT were subsequently graded independently by 2 masked graders for the presence of bull’s eye maculopathy, and the result was compared to the outcome of the screening. A total of 123 participants (246 eyes) were included, and 101 (90%) were female. The patients’ mean age was 55.2 ± 13.8 years. The mean time of HCQ usage was 84.0 ± 72.3 months, and the mean weekly dose was 2327 ± 650 mg. Two eyes showed toxicity in all 3 routine screening exams, with one patient suspending HCQ. The prevalence of bull´s eye lesions in NIR was 13% (33 eyes) with substantial intergrader agreement, a 71.3% specificity and 88.0% negative predictive value for HCQ toxicity. We suggest that NIR changes may be a sign of early HCQ toxicity. The detection of NIR bull´s eye lesions may warrant an increased screening frequency. |
| first_indexed | 2024-03-11T09:49:40Z |
| format | Article |
| id | doaj.art-f7fc630faeb74f518269a210b3b9f02b |
| institution | Directory Open Access Journal |
| issn | 2075-4418 |
| language | English |
| last_indexed | 2024-03-11T09:49:40Z |
| publishDate | 2023-01-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Diagnostics |
| spelling | doaj.art-f7fc630faeb74f518269a210b3b9f02b2023-11-16T16:24:49ZengMDPI AGDiagnostics2075-44182023-01-0113344510.3390/diagnostics13030445Bull’s Eye Maculopathy in Near-Infrared Reflectance as An Early Sign of Hydroxychloroquine ToxicityMiguel Santos0Inês Leal1Tiago Morais Sarmento2Sofia Sousa Mano3Patrícia José4Sara Vaz-Pereira5Department of Ophthalmology, Centro Hospitalar Universitário de Lisboa Norte, EPE—Hospital de Santa Maria, 1649-035 Lisbon, PortugalDepartment of Ophthalmology, Centro Hospitalar Universitário de Lisboa Norte, EPE—Hospital de Santa Maria, 1649-035 Lisbon, PortugalInstituto de Microcirurgia Ocular Lisboa, IMO Lisboa, 1600-209 Lisbon, PortugalDepartment of Ophthalmology, Centro Hospitalar Universitário de Lisboa Norte, EPE—Hospital de Santa Maria, 1649-035 Lisbon, PortugalDepartment of Ophthalmology, Centro Hospitalar Universitário de Lisboa Norte, EPE—Hospital de Santa Maria, 1649-035 Lisbon, PortugalDepartment of Ophthalmology, Centro Hospitalar Universitário de Lisboa Norte, EPE—Hospital de Santa Maria, 1649-035 Lisbon, PortugalHydroxychloroquine (HCQ) ocular toxicity is rare but severe, and progression can occur even after termination of therapy. Case reports have suggested that a bull’s eye maculopathy detected by near-infrared reflectance (NIR) may indicate early HCQ toxicity. This retrospective cross-sectional study evaluated patients treated with HCQ who underwent routine screening with optical coherence tomography (OCT), fundus autofluorescence (FAF) and 10-2 perimetry. NIR images captured alongside OCT were subsequently graded independently by 2 masked graders for the presence of bull’s eye maculopathy, and the result was compared to the outcome of the screening. A total of 123 participants (246 eyes) were included, and 101 (90%) were female. The patients’ mean age was 55.2 ± 13.8 years. The mean time of HCQ usage was 84.0 ± 72.3 months, and the mean weekly dose was 2327 ± 650 mg. Two eyes showed toxicity in all 3 routine screening exams, with one patient suspending HCQ. The prevalence of bull´s eye lesions in NIR was 13% (33 eyes) with substantial intergrader agreement, a 71.3% specificity and 88.0% negative predictive value for HCQ toxicity. We suggest that NIR changes may be a sign of early HCQ toxicity. The detection of NIR bull´s eye lesions may warrant an increased screening frequency.https://www.mdpi.com/2075-4418/13/3/445bull’s eye maculopathydiagnostic imaginghydroxychloroquine toxicitynear-infrared reflectance imagingoptical coherence tomography |
| spellingShingle | Miguel Santos Inês Leal Tiago Morais Sarmento Sofia Sousa Mano Patrícia José Sara Vaz-Pereira Bull’s Eye Maculopathy in Near-Infrared Reflectance as An Early Sign of Hydroxychloroquine Toxicity Diagnostics bull’s eye maculopathy diagnostic imaging hydroxychloroquine toxicity near-infrared reflectance imaging optical coherence tomography |
| title | Bull’s Eye Maculopathy in Near-Infrared Reflectance as An Early Sign of Hydroxychloroquine Toxicity |
| title_full | Bull’s Eye Maculopathy in Near-Infrared Reflectance as An Early Sign of Hydroxychloroquine Toxicity |
| title_fullStr | Bull’s Eye Maculopathy in Near-Infrared Reflectance as An Early Sign of Hydroxychloroquine Toxicity |
| title_full_unstemmed | Bull’s Eye Maculopathy in Near-Infrared Reflectance as An Early Sign of Hydroxychloroquine Toxicity |
| title_short | Bull’s Eye Maculopathy in Near-Infrared Reflectance as An Early Sign of Hydroxychloroquine Toxicity |
| title_sort | bull s eye maculopathy in near infrared reflectance as an early sign of hydroxychloroquine toxicity |
| topic | bull’s eye maculopathy diagnostic imaging hydroxychloroquine toxicity near-infrared reflectance imaging optical coherence tomography |
| url | https://www.mdpi.com/2075-4418/13/3/445 |
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