Early detection of hydroxychloroquine-related changes with fundus autofluorescence: confocal scanning laser ophthalmoscope versus fundus camera

Abstract

Objective The aim of this study was to detect early fundus changes accompanying hydroxychloroquine (HCQ) treatment by using fundus autofluorescence (FAF) with confocal scanning laser ophthalmoscope (CSLO) in comparison to fundus camera. Patients and methods This is a cross-sectional study of 80 eyes of 40 rheumatoid arthritis patients on HCQ treatment. All patients were subjected to full and detailed history taking and ophthalmic examination followed by fundus imaging using fundus camera (colored and FAF images) and the CSLO image. Results The mean age of the patients was 43.75±8.71 years. The HCQ treatment duration ranged from 2 to 60 months with a mean of 29.12±19.42 months. The FAF by fundus camera had a 57% sensitivity in detecting hyperfluorescent lesions and 96% specificity in detecting negative lesions in relation to fundus picture, whereas FAF by CSLO had a 43% sensitivity in detecting hyperfluorescent lesions, and 88% specificity in detecting negative lesions in relation to fundus picture. CSLO had a 29% sensitivity in detecting hyperfluorescent lesions and 86% specificity in detecting negative lesions in relation to FAF by a fundus camera. There were no significant associations between the duration of HCQ treatment and the findings detected by different methods. Conclusion FAF showed damage at a relatively early stage of HCQ toxicity, although it was not predicable which technique of FAF detection will be most definitive for any given individual. FAF by fundus camera was superior to FAF by CSLO as it had high sensitivity and less specificity.

Keywords

• confocal scanning laser ophthalmoscope
• fundus autofluorescence
• hydroxychloroquine
• rheumatoid arthritis