Journal francais d'ophtalmologie · 2026
Uncovering subclinical retinal toxicity: The role of macular thickness mapping inhydroxychloroquine screening.
СтатьяНаблюдательное исследованиеНазвание и аннотация: Перевод в очереди
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Khallouli A, Selmi S, Oueslati Y, Arfaoui B, Maalej A
Аннотация
PURPOSE: To evaluate the value of quantitative macular thickness mapping using spectral-domain optical coherence tomography (SD-OCT) as an early screening tool for preclinical hydroxychloroquine-induced retinal toxicity.
METHODS: This observational cross-sectional study included 122 patients receiving hydroxychloroquine. Established hydroxychloroquine retinal toxicity was defined according to classical structural and functional criteria, including ellipsoid zone disruption on SD-OCT and confirmatory abnormalities on 10-2 visual field testing, fundus autofluorescence, and/or multifocal electroretinography. Patients fulfilling these criteria were identified separately and excluded from intergroup quantitative analyses. The remaining patients were stratified according to treatment duration into a higher-exposure group (≥ 5 years) and a lower-exposure group (< 5 years). All participants underwent SD-OCT and 10-2 visual field testing. Macular thickness, ganglion cell complex (GCC), and retinal nerve fiber layer (RNFL) parameters were compared, and correlations with hydroxychloroquine treatment characteristics were analyzed.
RESULTS: Macular thickness was significantly reduced in patients with longer hydroxychloroquine exposure, particularly in the parafoveal and perifoveal regions (mean parafoveal thickness: 323.05±12.12μm vs. 311.54±16.09μm; P=0.01). Parafoveal thinning correlated negatively with cumulative dose and treatment duration (r=-0.39, P=0.038 and r=-0.46, P=0.041, respectively). GCC thinning reached statistical significance only in the hemi-inferior quadrant, while RNFL parameters showed no significant differences or correlations.
CONCLUSION: Quantitative macular thickness reduction, particularly in the parafoveal region, is associated with hydroxychloroquine exposure and may precede classical structural signs of retinal toxicity. Macular thickness mapping by SD-OCT should be interpreted as a complementary early screening tool rather than a diagnostic criterion for established hydroxychloroquine maculopathy.
METHODS: This observational cross-sectional study included 122 patients receiving hydroxychloroquine. Established hydroxychloroquine retinal toxicity was defined according to classical structural and functional criteria, including ellipsoid zone disruption on SD-OCT and confirmatory abnormalities on 10-2 visual field testing, fundus autofluorescence, and/or multifocal electroretinography. Patients fulfilling these criteria were identified separately and excluded from intergroup quantitative analyses. The remaining patients were stratified according to treatment duration into a higher-exposure group (≥ 5 years) and a lower-exposure group (< 5 years). All participants underwent SD-OCT and 10-2 visual field testing. Macular thickness, ganglion cell complex (GCC), and retinal nerve fiber layer (RNFL) parameters were compared, and correlations with hydroxychloroquine treatment characteristics were analyzed.
RESULTS: Macular thickness was significantly reduced in patients with longer hydroxychloroquine exposure, particularly in the parafoveal and perifoveal regions (mean parafoveal thickness: 323.05±12.12μm vs. 311.54±16.09μm; P=0.01). Parafoveal thinning correlated negatively with cumulative dose and treatment duration (r=-0.39, P=0.038 and r=-0.46, P=0.041, respectively). GCC thinning reached statistical significance only in the hemi-inferior quadrant, while RNFL parameters showed no significant differences or correlations.
CONCLUSION: Quantitative macular thickness reduction, particularly in the parafoveal region, is associated with hydroxychloroquine exposure and may precede classical structural signs of retinal toxicity. Macular thickness mapping by SD-OCT should be interpreted as a complementary early screening tool rather than a diagnostic criterion for established hydroxychloroquine maculopathy.