New proposal for a multimodal imaging approach for the subclinical detection of hydroxychloroquine-induced retinal toxicity in patients with systemic lupus erythematosus
Objective To compare multimodal structural and functional diagnostic methods in patients with systemic lupus erythematosus (SLE) treated with hydroxychloroquine, to identify the best complementary approach for detecting subclinical retinal toxicity.Methods A cross-sectional, unicentric study was con...
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BMJ Publishing Group
2024-05-01
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| Series: | BMJ Open Ophthalmology |
| Online Access: | https://bmjophth.bmj.com/content/9/1/e001608.full |
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| author | Ricard Cervera Alfredo Adan Gerard Espinosa Jose Rios Olga Araujo José Hernández-Rodríguez Laura Pelegrín Ricardo P Casaroli-Marano Halbert Hernández-Negrín Marc Figueras-Roca Vanesa Budi Montse Morató |
| author_facet | Ricard Cervera Alfredo Adan Gerard Espinosa Jose Rios Olga Araujo José Hernández-Rodríguez Laura Pelegrín Ricardo P Casaroli-Marano Halbert Hernández-Negrín Marc Figueras-Roca Vanesa Budi Montse Morató |
| author_sort | Ricard Cervera |
| collection | DOAJ |
| description | Objective To compare multimodal structural and functional diagnostic methods in patients with systemic lupus erythematosus (SLE) treated with hydroxychloroquine, to identify the best complementary approach for detecting subclinical retinal toxicity.Methods A cross-sectional, unicentric study was conducted on patients with SLE treated with hydroxychloroquine. Each patient underwent a comprehensive ophthalmic evaluation, comprising structural tests (spectral-domain optical coherence tomography (SD-OCT), en face OCT, en face OCT angiography (OCTA), fundus autofluorescence (FAF)) and functional tests (automated perimetry for visual field (VF) testing, multifocal electroretinography (mfERG)). A diagnosis of macular toxicity required the presence of abnormalities in at least one structural and functional test. The Kappa Concordance Index was used to assess the concordance among the different tests in detecting potential macular toxicity-associated alterations.Results Sixty-six patients with SLE (132 eyes) were consecutively enrolled. Four (6.1%) patients developed subclinical hydroxychloroquine-induced retinal toxicity without visual acuity impairment. The proportion of abnormal results was 24% for both en face OCT and en face OCTA. Regarding functional analysis, VF was less specific than mfERG in detecting subclinical retinal toxicity (VF specificity 47.5%). En face OCT and en face OCTA structural findings showed better concordance, with a kappa index >0.8, and both identified the same cases of toxicity as FAF.Conclusion Although structural OCT and VF are frequently used to screen for hydroxychloroquine-induced retinal toxicity, our findings suggest that a combination of mfERG, en face OCT and en face OCTA could improve the diagnostic accuracy for subclinical retinal damage. This study emphasises the importance of a multimodal imaging strategy to promptly detect signs of hydroxychloroquine-induced retinal toxicity. |
| format | Article |
| id | doaj-art-c2c6c687194a47f098d3e280aadb9df1 |
| institution | Kabale University |
| issn | 2397-3269 |
| language | English |
| publishDate | 2024-05-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open Ophthalmology |
| spelling | doaj-art-c2c6c687194a47f098d3e280aadb9df12025-02-06T13:55:09ZengBMJ Publishing GroupBMJ Open Ophthalmology2397-32692024-05-019110.1136/bmjophth-2023-001608New proposal for a multimodal imaging approach for the subclinical detection of hydroxychloroquine-induced retinal toxicity in patients with systemic lupus erythematosusRicard Cervera0Alfredo Adan1Gerard Espinosa2Jose Rios3Olga Araujo4José Hernández-Rodríguez5Laura Pelegrín6Ricardo P Casaroli-Marano7Halbert Hernández-Negrín8Marc Figueras-Roca9Vanesa Budi10Montse Morató117 Department of Autoimmune Diseases, Hospital Clínic, Institut d’Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Catalonia, SpainDepartment of Ophthalmology, Hospital Clinic de Barcelona, Institut d`Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Catalonia, Spain5 Barcelona University, Barcelona, SpainDepartment of Medical Statistics Platform, Hospital Clínic of Barcelona, Institut d`Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Catalonia, SpainDepartment of Autoimmune Diseases, Reference Centre for Systemic Autoimmune Diseases, Vasculitis and Autoinflammatory Diseases (UEC/CSUR) of the Catalan and Spanish Health Systems. Member of ERN-ReCONNET/RITA. Hospital Clínic de Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Catalonia, SpainDepartment of Autoimmune Diseases, Reference Centre for Systemic Autoimmune Diseases, Vasculitis and Autoinflammatory Diseases (UEC/CSUR) of the Catalan and Spanish Health Systems. Member of ERN-ReCONNET/RITA. Hospital Clínic de Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Catalonia, SpainDepartment of Ophthalmology, Hospital Clinic de Barcelona, Institut d`Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Catalonia, SpainDepartment of Ophthalmology, Hospital Clinic de Barcelona, Institut d`Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Catalonia, SpainDepartment of Autoimmune Diseases, Reference Centre for Systemic Autoimmune Diseases, Vasculitis and Autoinflammatory Diseases (UEC/CSUR) of the Catalan and Spanish Health Systems. Member of ERN-ReCONNET/RITA. Hospital Clínic de Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Catalonia, SpainDepartment of Ophthalmology, Hospital Clinic de Barcelona, Institut d`Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Catalonia, SpainDepartment of Ophthalmology, Hospital Clinic de Barcelona, Institut d`Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Catalonia, SpainDepartment of Ophthalmology, Hospital Clinic de Barcelona, Institut d`Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Catalonia, SpainObjective To compare multimodal structural and functional diagnostic methods in patients with systemic lupus erythematosus (SLE) treated with hydroxychloroquine, to identify the best complementary approach for detecting subclinical retinal toxicity.Methods A cross-sectional, unicentric study was conducted on patients with SLE treated with hydroxychloroquine. Each patient underwent a comprehensive ophthalmic evaluation, comprising structural tests (spectral-domain optical coherence tomography (SD-OCT), en face OCT, en face OCT angiography (OCTA), fundus autofluorescence (FAF)) and functional tests (automated perimetry for visual field (VF) testing, multifocal electroretinography (mfERG)). A diagnosis of macular toxicity required the presence of abnormalities in at least one structural and functional test. The Kappa Concordance Index was used to assess the concordance among the different tests in detecting potential macular toxicity-associated alterations.Results Sixty-six patients with SLE (132 eyes) were consecutively enrolled. Four (6.1%) patients developed subclinical hydroxychloroquine-induced retinal toxicity without visual acuity impairment. The proportion of abnormal results was 24% for both en face OCT and en face OCTA. Regarding functional analysis, VF was less specific than mfERG in detecting subclinical retinal toxicity (VF specificity 47.5%). En face OCT and en face OCTA structural findings showed better concordance, with a kappa index >0.8, and both identified the same cases of toxicity as FAF.Conclusion Although structural OCT and VF are frequently used to screen for hydroxychloroquine-induced retinal toxicity, our findings suggest that a combination of mfERG, en face OCT and en face OCTA could improve the diagnostic accuracy for subclinical retinal damage. This study emphasises the importance of a multimodal imaging strategy to promptly detect signs of hydroxychloroquine-induced retinal toxicity.https://bmjophth.bmj.com/content/9/1/e001608.full |
| spellingShingle | Ricard Cervera Alfredo Adan Gerard Espinosa Jose Rios Olga Araujo José Hernández-Rodríguez Laura Pelegrín Ricardo P Casaroli-Marano Halbert Hernández-Negrín Marc Figueras-Roca Vanesa Budi Montse Morató New proposal for a multimodal imaging approach for the subclinical detection of hydroxychloroquine-induced retinal toxicity in patients with systemic lupus erythematosus BMJ Open Ophthalmology |
| title | New proposal for a multimodal imaging approach for the subclinical detection of hydroxychloroquine-induced retinal toxicity in patients with systemic lupus erythematosus |
| title_full | New proposal for a multimodal imaging approach for the subclinical detection of hydroxychloroquine-induced retinal toxicity in patients with systemic lupus erythematosus |
| title_fullStr | New proposal for a multimodal imaging approach for the subclinical detection of hydroxychloroquine-induced retinal toxicity in patients with systemic lupus erythematosus |
| title_full_unstemmed | New proposal for a multimodal imaging approach for the subclinical detection of hydroxychloroquine-induced retinal toxicity in patients with systemic lupus erythematosus |
| title_short | New proposal for a multimodal imaging approach for the subclinical detection of hydroxychloroquine-induced retinal toxicity in patients with systemic lupus erythematosus |
| title_sort | new proposal for a multimodal imaging approach for the subclinical detection of hydroxychloroquine induced retinal toxicity in patients with systemic lupus erythematosus |
| url | https://bmjophth.bmj.com/content/9/1/e001608.full |
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