HİDROKSİKLOROKİNİN NEDEN OLDUĞU RETİNAL TOKSİSİTE

AMAÇ: Hidroksiklorokin kullanan romatoid artritli hastalarda retinal toksisitenin belirlenmesinde, görme alanı,fundus fotoğraf, retina sinir lifi kalınlığı (RNFL), fundus otofloresans(FAF), multifokal elektroretinogram(mfERG) sonuçlarının karşılaştırılması amaçlandı.GEREÇ VE YÖNTEMLER: Şubat ile Haziran 2015 tarihleri arasında Ankara Eğitim ve Araştırma hastanesi göz polikliğine başvuran hidroksiklorokin kullanan 23 romatoid artritli hasta incelendi. Tüm hastaların düzeltilmiş görme keskinlikleri, biomikroskobik muayeneleri ve fundus muayeneleri yapıldı.Daha sonra, hastalara fundus fotografı, Humphrey görme alanı testi, optik koherens tomografi (OCT), FAF, mfERG yapıldı. BULGULAR: Çalışmaya yaşları ortalama 57,9 ± 9,9 yıl (35-75 yıl) olan 23 romatoid artritli hastanın 46 gözü alındı. Bunların 17 'si kadın, 6'sı erkek idi. Tüm hastalar hidroksiklorokini güvenilir dozu olan 6,5 mg/kg/gün şeklinde almaktaydı. Hastalar ortalama 7,6 ± 6,04 ay (4-42ay) hidroksiklorokin kullanmaktaydı. Hiçbir hastada fundus muayenesinde ve görme alanında patoloji saptanmadı. 46 gözün 8'inde (%17) RNFL'de incelme saptandı. 46 gözün 4'unde (%8,69) FAF sonuçlarında patoloji görüldü. 46 gözün 10 'unda (%22) mfERG 'de anormallik saptandı.SONUÇ: RNFL, FAF, mfERG; hidroksiklorokinin neden olduğu retinal toksisitenin belirlenmesinde son derece önemli olup, erken dönemdeki retinal değişikliklerin saptanmasında diğer testler oranla daha sensitiftirler. Retinal değişikleri erken belirlemek için,ilaç kullanımı süresince her 3 ayda bir bu testlerin yapılması önerilebilir.

RETINAL TOXICITY BECAUSE OF HYDROXYCHLOROQUINE

OBJECTIVE: ATo compare visual field testing, fundus imaging, retinal nerve fiber layer thickness (RNFL), fundusautofluorescence (FAF) and multifocal electroretinography (mfERG) results in the detection of retinal toxicity of hydroxychloroquineuse in patients with rheumatoid arthritis.MATERIAL AND METHODS: Twenty three patients who were using hydroxychloroquine due to rheumatoid arthritisadmitted to ophthalmology clinic of Ankara Training and Research Hospital as outpatients from February to June2015 were enrolled in the study. In all patients, best-corrected visual acuity assessment, biomicroscopic examination,fundus examination, fundus photography, Humprey visual field testing, optic coherence tomography (OCT), FAF andmfERG were performed.RESULTS: Mean age was 57,9 ± 9,9 years (range, 35-75). Forty six eyes of 23 patients were assessed. Seventy patientswere female and 6 were male. All patients were receiving the safe dose of hydroxichloroquine of 6.5 mg/kg/day. Meantime of hydroxychloroquine use was 7,6 ± 6,04 months (range, 4-42 mo). No pathology was encountered in fundusexamination and visual field testing in any of the patients. In 8 eyes (17%) thinning in RNFL was detected. Pathologyin FAF was observed in 4 eyes (8.69%). Abnormality in mfERG was observed in 10 eyes (22%).DISCUSSION: RNFL, FAF, mfERG analysis is quite important in the detection of retinal toxicity secondary to hydroxychloroquine.They are also more sensitive in the detection of early retinal changes than other tests. For earlydetection of retinal changes, these tests can be performed regularly at every 3 months.

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