Structural and functional assessment of ganglion cell complex in patients on long-term hydroxychloroquine
Purpose: Long-term hydroxychloroquine (HCQ) treatment has been shown to be associated with structural changes (reduced thickness) of ganglion cell complex (GCC). This study evaluated if these structural changes of GCC translate to functional deficits and if they represent true retinal toxicity. Meth...
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| Format: | Article |
| Language: | English |
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Wolters Kluwer Medknow Publications
2025-05-01
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| Series: | Indian Journal of Ophthalmology |
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| Online Access: | https://journals.lww.com/10.4103/IJO.IJO_2117_24 |
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| author | Shreyas Temkar Aniket Tatyasaheb Mairal Arun Sahi Amit Kumar Deb Chengappa G Kavadichanda Subashini Kaliaperumal Veeradasari Jawahar Satya Babu Aarthy Gunasekaran |
| author_facet | Shreyas Temkar Aniket Tatyasaheb Mairal Arun Sahi Amit Kumar Deb Chengappa G Kavadichanda Subashini Kaliaperumal Veeradasari Jawahar Satya Babu Aarthy Gunasekaran |
| author_sort | Shreyas Temkar |
| collection | DOAJ |
| description | Purpose:
Long-term hydroxychloroquine (HCQ) treatment has been shown to be associated with structural changes (reduced thickness) of ganglion cell complex (GCC). This study evaluated if these structural changes of GCC translate to functional deficits and if they represent true retinal toxicity.
Methods:
This was a cross-sectional study. Fifteen patients aged ≥18 years who had been on HCQ treatment for >5 years were recruited as cases, and 15 age- and gender-matched healthy individuals were recruited as controls. All cases underwent visual fields (central 10-2 SITA standard), pattern electroretinogram (ERG), spectral-domain optical coherence tomography (OCT), and widefield autofluorescence. Controls underwent pattern ERG and spectral-domain OCT.
Results:
A significantly lower average (77.0 ± 5.5 µm vs. 82.0 ± 5.3 µm, P = 0.017) and minimum ganglion cell-inner plexiform layer (GC-IPL) thickness (71.0 ± 8.1 µm vs. 76.6 ± 6.3 µm, P = 0.041) were noted among cases compared to controls. Similarly, average retinal nerve fiber layer (RNFL) thickness (86.7 ± 9.6 µm vs. 94.8 ± 7.6 µm, P = 0.015) and superior quadrant RNFL thickness (105.2 µm ± 16.7 µm vs. 120.0 µm ± 15.6 µm, P = 0.018) were lower in cases than in controls. Average RNFL thickness and GC-IPL thickness were negatively correlated with the mean deviation (MD), the pattern standard deviation (PSD) scores, and implicit times of P50 and N95 waveforms, respectively, but none were statistically significant.
Conclusion:
Long-term HCQ use is associated with structural changes in the GCC, manifested as lower GC-IPL and RNFL thickness. Although there was a trend suggesting ganglion cell dysfunction (prolonged implicit times) and possible deficits in RNFL function (MD and PSD scores), statistically significant correlations could not be established with GC-IPL and RNFL thickness, respectively. GC-IPL/RNFL thickness assessment can be a part of the screening. Mere GC-IPL thickness reduction should not be a criterion to recommend HCQ cessation in the absence of abnormality on routinely recommended screening tests. |
| format | Article |
| id | doaj-art-e6c1672110df46c993a7ec5a876ae29d |
| institution | Kabale University |
| issn | 0301-4738 1998-3689 |
| language | English |
| publishDate | 2025-05-01 |
| publisher | Wolters Kluwer Medknow Publications |
| record_format | Article |
| series | Indian Journal of Ophthalmology |
| spelling | doaj-art-e6c1672110df46c993a7ec5a876ae29d2025-08-20T03:52:16ZengWolters Kluwer Medknow PublicationsIndian Journal of Ophthalmology0301-47381998-36892025-05-0173570871210.4103/IJO.IJO_2117_24Structural and functional assessment of ganglion cell complex in patients on long-term hydroxychloroquineShreyas TemkarAniket Tatyasaheb MairalArun SahiAmit Kumar DebChengappa G KavadichandaSubashini KaliaperumalVeeradasari Jawahar Satya BabuAarthy GunasekaranPurpose: Long-term hydroxychloroquine (HCQ) treatment has been shown to be associated with structural changes (reduced thickness) of ganglion cell complex (GCC). This study evaluated if these structural changes of GCC translate to functional deficits and if they represent true retinal toxicity. Methods: This was a cross-sectional study. Fifteen patients aged ≥18 years who had been on HCQ treatment for >5 years were recruited as cases, and 15 age- and gender-matched healthy individuals were recruited as controls. All cases underwent visual fields (central 10-2 SITA standard), pattern electroretinogram (ERG), spectral-domain optical coherence tomography (OCT), and widefield autofluorescence. Controls underwent pattern ERG and spectral-domain OCT. Results: A significantly lower average (77.0 ± 5.5 µm vs. 82.0 ± 5.3 µm, P = 0.017) and minimum ganglion cell-inner plexiform layer (GC-IPL) thickness (71.0 ± 8.1 µm vs. 76.6 ± 6.3 µm, P = 0.041) were noted among cases compared to controls. Similarly, average retinal nerve fiber layer (RNFL) thickness (86.7 ± 9.6 µm vs. 94.8 ± 7.6 µm, P = 0.015) and superior quadrant RNFL thickness (105.2 µm ± 16.7 µm vs. 120.0 µm ± 15.6 µm, P = 0.018) were lower in cases than in controls. Average RNFL thickness and GC-IPL thickness were negatively correlated with the mean deviation (MD), the pattern standard deviation (PSD) scores, and implicit times of P50 and N95 waveforms, respectively, but none were statistically significant. Conclusion: Long-term HCQ use is associated with structural changes in the GCC, manifested as lower GC-IPL and RNFL thickness. Although there was a trend suggesting ganglion cell dysfunction (prolonged implicit times) and possible deficits in RNFL function (MD and PSD scores), statistically significant correlations could not be established with GC-IPL and RNFL thickness, respectively. GC-IPL/RNFL thickness assessment can be a part of the screening. Mere GC-IPL thickness reduction should not be a criterion to recommend HCQ cessation in the absence of abnormality on routinely recommended screening tests.https://journals.lww.com/10.4103/IJO.IJO_2117_24drug toxicityganglion cell complexhydroxychloroquinepattern electroretinogramretinopathy |
| spellingShingle | Shreyas Temkar Aniket Tatyasaheb Mairal Arun Sahi Amit Kumar Deb Chengappa G Kavadichanda Subashini Kaliaperumal Veeradasari Jawahar Satya Babu Aarthy Gunasekaran Structural and functional assessment of ganglion cell complex in patients on long-term hydroxychloroquine Indian Journal of Ophthalmology drug toxicity ganglion cell complex hydroxychloroquine pattern electroretinogram retinopathy |
| title | Structural and functional assessment of ganglion cell complex in patients on long-term hydroxychloroquine |
| title_full | Structural and functional assessment of ganglion cell complex in patients on long-term hydroxychloroquine |
| title_fullStr | Structural and functional assessment of ganglion cell complex in patients on long-term hydroxychloroquine |
| title_full_unstemmed | Structural and functional assessment of ganglion cell complex in patients on long-term hydroxychloroquine |
| title_short | Structural and functional assessment of ganglion cell complex in patients on long-term hydroxychloroquine |
| title_sort | structural and functional assessment of ganglion cell complex in patients on long term hydroxychloroquine |
| topic | drug toxicity ganglion cell complex hydroxychloroquine pattern electroretinogram retinopathy |
| url | https://journals.lww.com/10.4103/IJO.IJO_2117_24 |
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