Microperimetric sensitivity in patients on hydroxychloroquine (Plaquenil) therapy.

PURPOSE: The purpose of this study was to measure macular sensitivity using microperimetry in patients on Plaquenil therapy without evidence of retinopathy as assessed by recommended screening standards. METHODS: Sixteen patients from a clinical practice treated with 200 or 400 mg/day of Plaquenil for more than 5 years, without visual complaints (visual acuity 20/25 or better), and without a history of diabetes or macular disease were included. Participants underwent a complete ophthalmic examination with spectral-domain optical coherence tomography (SD-OCT), 10-2 Humphrey visual field (HVF), fundus autofluoresecene (FAF), multifocal electroretinography (mfERG), and microperimetry that covered the central 12° of the visual field. Ten age-similar, visually normal subjects served as controls. RESULTS: The average age of the study cohort was of 54.5 years, with an average daily Plaquenil dose of 4.00 mg/kg/day (range, 1.77-6.67 mg/kg/day) and an average cumulative dose of 1485 g (range, 256-3650 g). All patients had normal ocular exams, and no evidence of retinopathy based on 10-2 HVF, FAF, mfERG, and SD-OCT. The mean retinal sensitivity by microperimetry was 15.0 dB (OD) and 14.6 dB (OS). The overall mean microperimetry sensitivity of the patients (14.7±1.9 dB) was significantly lower (P<0.001) than that of the controls (16.5±2.1 dB). CONCLUSIONS: Patients on Plaquenil without clinical evidence of retinal toxicity can have reduced retinal sensitivity, as assessed by microperimetry. The mean sensitivity difference between the patients and controls suggests that microperimetry can provide important information regarding visual function in patients on Plaquenil therapy.

Cystic macular oedema on spectral-domain optical coherence tomography in choroideremia patients without cystic changes on fundus examination.

PURPOSE: To determine the prevalence of cystic macular oedema (CME) in patients with choroideremia (CHM) by using spectral-domain optical coherence tomography (SD-OCT). METHODS: A total 16 patients affected with CHM were enrolled in the study. All patients underwent a complete eye examination. SD-OCT was performed using an OPKO spectral-domain OCT/SLO instrument. RESULTS: The average age of the study patients was 44.0 ± 16.0 years (range, 13-63 years). Out of the 16 patients with CHM, 10 patients (62.5%) showed a degree of CME on SD-OCT testing in at least one eye, and 8 patients (50%) showed CME in both eyes. CONCLUSIONS: Because of its notable prevalence, it would seem prudent to screen CHM patients by SD-OCT for the possible presence of CME and to identify those amenable to future treatment strategies for their macular oedema.

Retinal nerve fibre layer thickness analysis in X-linked retinoschisis using Fourier-domain OCT.

PURPOSE: To evaluate the presence of retinal nerve fibre layer (RNFL) defects in patients with X-linked retinoschisis (XLRS) using high-speed, high-resolution, Fourier domain OCT (FD-OCT). METHODS: Twenty-four patients with XLRS seen by the authors were enrolled in the study. All patients underwent a complete eye examination. FD-OCT was performed using Optovue technology. A quadrant of the RNFL was considered to be thinned if at least two of the four segments in the quadrant were reduced in thickness. RESULTS: The average age of the 24 patients in the study was 28.8+/-14.7 years. Thinning of the RNFL in one quadrant was seen in 10 patients (41.7%), and thinning in two or more quadrants was seen in 8 patients (33.3%). Thinning in the inferior quadrant was most commonly seen and was observed in 12 patients (50%), followed by the temporal quadrant in 8 patients (33.3%), nasal quadrant in 4 patients (16.7%), and the superior quadrant in 4 patients (16.7%). CONCLUSIONS: Among our 24 patients with XLRS, 15 patients (62.5%) showed a thinning of the RNFL in one or more quadrants in at least one eye and 9 patients (37.5%) in both eyes. High-speed, high-resolution FD-OCT may be useful to determine the presence of possible changes in RNFL thickness in patients with XLRS. Reductions in RNFL thickness in such patients could be relevant in their selection for future therapeutic trials.