Nuzzi Raffaele, Geronazzo Giada, Tridico Federico, Nuzzi Alessia, Caselgrandi Paolo, Piga Antonio Giulio
Eye Clinic Section, Department of Surgical Sciences, University of Turin, Turin, Italy.
Regional Reference Centre for Diagnosis and Cure of Hemoglobinopathies, S. Luigi Gonzaga University Hospital, University of Turin, Orbassano (TO), Italy.
Clin Ophthalmol. 2021 May 20;15:2099-2109. doi: 10.2147/OPTH.S300974. eCollection 2021.
The aim of this study is to evaluate eye structures and function in patients receiving iron chelating therapy and to assess whether a correlation exists between the onset of ocular alterations and the intake of iron chelating drugs.
A prospective cohort study was performed. Eighty-eight patients, composed of children and adults with thalassemia major (TM) who are taking or had taken iron chelating drugs (deferoxamine, deferiprone or deferasirox), have been initially enrolled in the study. The final sample featured 80 patients, including 18 children and 62 adults. These subjects received an eye examination to evaluate intraocular pressure (IOP), best corrected visual acuity (BCVA), the presence of refractive defects, cornea, anterior chamber, lens, fundus oculi, visual field and mean retinal nerve fiber layer (RNFL) thickness. Logistic regression model analysis was performed in order to assess any correlation. In addition, a literature search regarding the relation between iron chelating drugs and ocular adverse events was carried out to compare the results obtained with the evidence in the literature.
Logistic regression did not report a significant correlation between the intake of iron chelating drugs and the onset of anterior ocular segment alterations, lens opacities, retinal diseases, optical neuropathies, astigmatism, visual field and RNFL thickness defects. Logistic regression returned a statistically significant correlation between myopia and iron chelation therapy (p-value 0.04; OR 1.05) and also between presbyopia and total duration of therapy with deferoxamine (p-value 0.03; OR 1.21). Although intraocular pressure levels remained within the normal range, a significant correlation with the length of deferoxamine therapy has been found (p-value 0.002; association coefficient -0.12). A negative correlation between deferiprone and presbyopia has also been observed.
Iron chelation therapy is not associated with severe visual function alterations. Limitation of deferoxamine treatment can help prevent ocular complications. Deferiprone and/or deferasirox may be preferable, especially in patients over age 40 years.
本研究旨在评估接受铁螯合治疗患者的眼部结构和功能，并评估眼部改变的发生与铁螯合药物的摄入之间是否存在相关性。
进行了一项前瞻性队列研究。最初纳入了88例患者，包括正在服用或曾服用铁螯合药物（去铁胺、地拉罗司或去铁酮）的重型地中海贫血（TM）儿童和成人。最终样本为80例患者，包括18名儿童和62名成人。这些受试者接受了眼部检查，以评估眼压（IOP）、最佳矫正视力（BCVA）、屈光缺陷的存在、角膜、前房、晶状体、眼底、视野和平均视网膜神经纤维层（RNFL）厚度。进行逻辑回归模型分析以评估任何相关性。此外，还进行了关于铁螯合药物与眼部不良事件之间关系的文献检索，以将获得的结果与文献中的证据进行比较。
逻辑回归未显示铁螯合药物的摄入与眼前节改变、晶状体混浊、视网膜疾病、视神经病变、散光、视野和RNFL厚度缺陷的发生之间存在显著相关性。逻辑回归显示近视与铁螯合治疗之间存在统计学显著相关性（p值0.04；OR 1.05），老花眼与去铁胺治疗的总时长之间也存在相关性（p值0.03；OR 1.21）。尽管眼压水平保持在正常范围内，但发现与去铁胺治疗的时长存在显著相关性（p值0.002；关联系数 -0.12）。还观察到去铁酮与老花眼之间存在负相关性。
铁螯合治疗与严重的视觉功能改变无关。限制去铁胺治疗有助于预防眼部并发症。去铁酮和/或地拉罗司可能更可取，尤其是在40岁以上的患者中。
