HİDROKSİKLOROKİN KULLANIMININ RETİNA VE KOROİD ÜZERİNE ETKİLERİNİN DEĞERLENDİRİLMESİ: RETROSPEKTİF OCT ÇALIŞMASI

Abstract

Amaç: Bu çalışmada hidroksiklorokin (HK) tedavisi gören ve belirgin retinal toksisitesi olmayan hastalarda retina, koroid ve koroid vaskülaritesinde etkilenme olup olmadığı araştırılmıştır. Gereç ve Yöntemler: Çalışmamız, HK tedavisi gören 51 hasta ve 24 sağlıklı gönüllü olmak üzere toplam 75 kişinin dâhil edildiği retrospektif vaka kontrol çalışmasıdır. Hasta grup, 5 yıldan az HK kullananlar (grup 1, 30 hasta) ile 5 yıl ve daha fazla HK kullananlar (grup 2, 21 hasta) olmak üzere iki grupta incelendi. Tüm katılımcıların oftalmolojik muayene raporları ve optik koherens tomografi (OKT) görüntüleri tarandı. HK’ye bağlı belirgin retinal toksisitesi bulunan hastalar çalışmaya dâhil edilmedi. OKT görüntülerinden alınan; peripapiller, foveal ve parafoveal retina tabakaları kalınlıkları, subfoveal koroid kalınlıkları ile koroid vaskülarite indeksi (KVİ) ölçümleri hesaplanarak kaydedildi. Bulgular: HK kullanan hastalarda subfoveal koroid kalınlığı her 2 grupta kontrol grubuna kıyasla anlamlı şekilde azalmıştır (sırasıyla p=0,035 ve p=0,014). Makular alanda 1-3 mm zonda inferior ve nazal parafoveal retina sinir lifi tabakası (RSLT), temporal parafoveal gangliyon hücre tabakası ve iç pleksiform tabaka kalınlıkları azalırken, temporal parafoveal retina pigment epitel tabakası kalınlıkları artmıştır. Peripapiller-RSLT ve KVİ ölçümlerinde gruplar arasında anlamlı bir farklılık görülmemiştir (p>0,05). Sonuç:Çalışmamız, HK kullanan ve belirgin bir retinal toksisitesi olmayan hastaların, retina ve koroid kalınlık ölçümlerinde bazı değişiklikler olduğunu göstermiştir. Gelecekte yapılacak daha geniş kapsamlı ve uzunlamasına klinik çalışmalar ile bu değişikliklerin, HK kullanan hastaların takibinde, retinopatinin erken tanısı için klinik belirteçler olarak kullanılabileceğini düşünmekteyiz.

Keywords

• Hidroksiklorokin
• retina
• koroid
• retina sinir lifi tabakası
• optik koherans tomografi

Evaluation of the Effects of Hydroxychloroquine Use on Retina and Choroid: A Retrospective OCT Study

Abstract

Objective: In this study we investigated whether retinal, choroidal and choroidal vascularity were affected in patients treated with hydroxychloroquine (HC) without significant retinal toxicity. Material and Methods: Our study was a retrospective case-control study in which 51 patients and 24 healthy volunteers were included. The patient group was divided into two groups: those who used HC for less than 5 years (group 1, 30 patients) and those who used HC for 5 years or more (group 2, 21 patients). Ophthalmologic examination reports and optical coherence tomography (OCT) images of all participants were scanned. Patients with significant retinal toxicity due to HC were excluded from the study. Peripapillary, foveal and parafoveal retinal layer thickness, subfoveal choroidal thickness and choroidal vascularity index (CVI) measurements were calculated and recorded from OCT images. Results: Subfoveal choroidal thickness was significantly reduced in both groups compared to the control group in HC groups (p=0.035 and p=0.014, respectively). In the macular area, inferior and nasal parafoveal retinal nerve fiber layer (RNFL), temporal parafoveal ganglion cell layer and inner plexiform layer thicknesses decreased, while temporal parafoveal retinal pigment epithelial layer thickness increased in the 1-3 mm zone. There was no significant difference between the groups in peripapillary-RNFL and CVI measurements (p>0.05). Conclusion:Our study showed that there were some changes in retinal and choroidal thickness measurements in patients who used HC without any significant retinal toxicity. With further clinical studies, we think that these changes can be used as clinical markers for the early diagnosis of retinopathy in the follow-up of patients using HC.

Keywords

• Hydroxychloroquine
• retina
• choroid
• retinal nerve fiber layer
• optical coherence tomography

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