Telek Hande Husniye, Yesilirmak Nilufer, Sungur Gulten, Ozdemir Yaprak, Yesil Nesibe Karahan, Ornek Firdevs
Department of Ophthalmology, Ankara Training and Research Hospital, Sukriye, Ulucanlar St. No. 89, Altindag, 06340, Ankara, Turkey.
Department of Statistics, Gazi University Faculty of Sciences, Ankara, Turkey.
Doc Ophthalmol. 2017 Dec;135(3):187-194. doi: 10.1007/s10633-017-9607-9. Epub 2017 Aug 29.
To compare the retinal toxicity due to hydroxychloroquine (HCQ) use in patients with systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA) using multifocal electroretinography (mfERG), fundus autofluorescence (FAF) and optical coherence tomography (OCT).
Patients who were using HCQ due to SLE and RA, and healthy subjects evaluated in this study. Central foveal thickness (CFT), inner-outer segment (IS-OS) junction irregularity, retinal nerve fiber layer thickness, mfERG and FAF measurements were performed to evaluate retinal toxicity.
Study included 35 eyes of 35 SLE patients, 40 eyes of 40 RA patients and 20 eyes of 20 healthy subjects. In SLE group, retinal abnormality was found in three eyes with mfERG, in one eye with FAF and in four eyes with OCT. In RA group, retinal abnormality was found in 10 eyes with mfERG, in five eyes with FAF and in nine eyes with OCT. A statistically significant difference was found with respect to mfERG between "eyes with abnormal responses and without abnormal responses" and "eyes with abnormal responses and controls" (p < 0.05). A statistically significant difference was found with respect to CFT between "eyes with IS-OS junction irregularities and without IS-OS junction irregularities" and "eyes with/without IS-OS junction irregularities and controls" (p < 0.05).
The use of HCQ seems to cause retinal toxicity more often in RA patients compared to SLE patients. For the early detection of retinal changes, OCT and mfERG can be used as screening tools due to their higher sensitivity rates compared to other tests.
使用多焦视网膜电图（mfERG）、眼底自发荧光（FAF）和光学相干断层扫描（OCT）比较系统性红斑狼疮（SLE）和类风湿关节炎（RA）患者使用羟氯喹（HCQ）后的视网膜毒性。
本研究纳入了因SLE和RA而使用HCQ的患者以及健康受试者。进行中心凹厚度（CFT）、内外节（IS-OS）交界处不规则性、视网膜神经纤维层厚度、mfERG和FAF测量以评估视网膜毒性。
研究包括35例SLE患者的35只眼、40例RA患者的40只眼和20名健康受试者的20只眼。在SLE组中，mfERG检查发现3只眼视网膜异常，FAF检查发现1只眼视网膜异常，OCT检查发现4只眼视网膜异常。在RA组中，mfERG检查发现10只眼视网膜异常，FAF检查发现5只眼视网膜异常，OCT检查发现9只眼视网膜异常。在“有异常反应和无异常反应的眼”与“有异常反应的眼和对照组”之间，mfERG存在统计学显著差异（p<0.05）。在“有IS-OS交界处不规则和无IS-OS交界处不规则的眼”与“有/无IS-OS交界处不规则的眼和对照组”之间，CFT存在统计学显著差异（p<0.05）。
与SLE患者相比，RA患者使用HCQ似乎更常引起视网膜毒性。为了早期发现视网膜变化，由于OCT和mfERG与其他检查相比具有更高的敏感性，可将其用作筛查工具。
