Microperimetry in hydroxychloroquine macular toxicity.

Objective: The aim was to evaluate the value of microperimetry (MP) in the early detection of toxic maculopathy caused by HCQ treatment in patients with normal fundoscopy, as well as normal structural optical coherence tomography (OCT). Materials and methods: Microperimetry was performed in 13 patients under hydroxychloroquine treatment, who did not present fundoscopic or structural OCT alterations compatible with maculopathy. We used Nidek MP3s equipment (Nidek, Gamagori, Japan) with a 13-point pattern centered in fovea, in mesopic mode and in scotopic mode. Results: The mean retinal sensitivity (MRS) in the study group was 27.25 +/ - 2.80 dB (95% CI 26.09 to 28.41 dB) while in the group of healthy volunteers 29.34 +/ - 2.18 dB (95% CI 28.67 to 30.1 dB). In scotopic mode, the mean sensitivity was 13.38 +/ - 1.43 dB (95% CI 12.79 to 13.97 dB) for HCQ users and 14.40 +/ - 2.1 dB (95% CI 13.76 to 15.04 dB) in the non-user group. Central retinal sensitivity (CRS) was also lower in patients using HCQ 26.52 +/ -4.0 dB (95% CI 24.8 to 28.15 dB) vs. 29.06 +/ - 2.5 dB (95% CI 28.33 to 29.87 dB) in the control group in mesopic mode. The trend was repeated in scotopic CRS (10.85 +/ -1.84 dB vs. 12.16 +/ - 2.61 dB respectively). Discussion: Our results showed that MP, especially in its mesopic mode, is a useful method to detect retinal toxicity caused by HCQ consumption in patients without funduscopic alteration and with normal macular OCT. Conclusions: In mesopic mode, MRS was significantly lower in patients with long-term hydroxychloroquine treatment compared to those who did not use it, even in cases in which no fundoscopic or structural OCT alteration was detected. Abbreviations: HCQ = hydroxychloroquine, MP = microperimetry, OCT = optical coherence tomography, BCVA = best corrected visual acuity, CRS = central retinal sensitivity, RS = retinal sensitivity, GEE = generalized estimating equations, MRS = mean retinal sensitivity, MfERG = multifocal electroretinogram, AMD = age-related macular degeneration.

Structure-Function Correlation Using OCT Angiography And Microperimetry In Diabetic Retinopathy.

PURPOSE: To evaluate macular vasculature in diabetic retinopathy (DR) with optical coherence tomography angiography (OCTA) and to correlate vessel density (VD) with retinal sensitivity (RS) as a way to assess structural and functional findings in DR. DESIGN: Prospective observational cross-sectional study. METHODS: Diabetic patients with DR but no clinically significant diabetic macular edema (DME) and healthy subjects were included in this study. All of them underwent comprehensive ophthalmic examination, best corrected visual acuity (BCVA), OCTA with RS-3000 Advance AngioScan (Nidek, Gamagori, Japan) and microperimetry with MP-3 (Nidek, Gamagori, Japan). Retinal vascular density measured by OCT angiography in 9 areas was correlated with RS in the same 9 areas by Spearman correlation. RESULTS: In this study, 50 subjects were enrolled: 25 eyes of diabetic patients with DR and 25 eyes of non-diabetic subjects. Diabetic patients mean age was 51.88±13.62 years; non-diabetic subjects were 43.48±13.42 years. The BCVA was 20/25 in the diabetic group and 20/20 in the non-diabetic group. Mean RS was decreased in the DR group (27.68±2.71 dB) compared to the non-diabetic group (31.68±1.46 dB) (p<0.05) and in the 9 studied areas (p<0.05). Mean VD was decreased in the DR group compared to non-diabetics (p<0.05) and in 7 of the 9 areas (except temporal superior and inferior squares) (p<0.05). Correlations by areas between VD and RS were assessed, we found moderate correlation in the area temporal to the fovea (r=0.501, p=0.01) in the DR group but not in the non-diabetic subjects. There were no other statistical significant correlations with this pattern. CONCLUSION: DR without DME results in a retinal VD decreased that might be the cause of a reduction of RS in one of the studied areas. Microangiopathic changes are correlated with microperimetry sensitivity drop in the temporal to the fovea grid but not in the other studied grids.

Intracameral cefuroxime and moxifloxacin used as endophthalmitis prophylaxis after cataract surgery: systematic review of effectiveness and cost-effectiveness.

Postoperative endophthalmitis is one of the most serious potential complications of ocular lens surgery. Its incidence can be reduced by means of antibiotic prophylaxis. Although the prophylactic use of intracameral cefuroxime has been extended, other drugs, such as moxifloxacin, have arisen as alternatives. We performed a systematic literature review on the effectiveness and efficiency of intracameral cefuroxime and moxifloxacin for the prophylaxis of postoperative endophthalmitis after cataract surgery. Several bibliographic databases were searched up to October 2010 and were updated up to January 2013. Outcomes were the onset of endophthalmitis after surgery and the cost-effectiveness ratio of using both antibiotic prophylaxis alternatives. The following were included: a clinical trial reported in two papers, six observational studies, and an economic evaluation. All studies assessed cefuroxime compared with another antibiotic prophylaxis or no prophylaxis. The only randomized controlled trial performed by the European Society of Cataract and Refractive Surgery found that intracameral cefuroxime is significantly more effective than not using prophylaxis or the use of a topical antibiotic. The observational studies support these results. The economic evaluation compared different prophylaxis regimens and concluded that intracameral cefuroxime showed the best cost-effectiveness ratio. Both the observational studies and the economic evaluation have methodological limits that reduce their validity. This review confirmed that cefuroxime can prevent endophthalmitis after cataract surgery. Further randomized controlled trials, with large sample sizes, are required to compare different antibiotic prophylaxis regimens.