Hidroksiklorokin Kullanan Retinal Toksisite Gelişmemiş Hastalarda Koroid Kalınlığı

Öz

Amaç: Hidroksiklorokin erken dönemde tespit edilmezse kalıcı retinal hasara sebep olabilen, iyi bilinen, antiromatizmal bir ilaçtır. Buna rağmen koroid tabakasına etkisini araştıran herhangi bir çalışma bulunmamaktadır. Bu çalışmada biz hidroksiklorokinin submaküler koroid kalınlığına etkisini değerlendirmeyi amaçladık.

Gereç ve Yöntem: Otuz hidroksiklorokin kullanan hasta ve otuz dokuz sağlıklı kontrol çalışmaya dahil edildi. Analizlerde yalnızca sağ gözler kullanıldı. Hasta ve kontrollerin demografik verileri kayıt edildi. Tüm hastaların refraksiyon, görme keskinliği, göz içi basıncı, 10-2 görme alanı testi, biyomikroskopi ve fundoskopik muayenelerini içeren oftalmolojik muayene bulguları kayıt edildi. Son olarak ise submaküler koroid kalınlığı arttırılmış derinlik görüntüleme-optik koherens tomografi (EDI-OKT) yöntemi ile 5 noktadan (subfoveal, nazal500, nazal1500, temporal500 ve temporal1500) ölçüldü.

Bulgular: Yaş, cinsiyet, göz içi basıncı ve görme keskinliği açısından gruplar arası anlamlı fark yoktu (P > 0,05). Ölçüm yapılan tüm noktalarda koroid kalınlığı hidroksiklorokin kullananlarda kontrollere göre istatiksel daha kalın idi (subfoveal; p < 0,05, nazal 500; p < 0,01, nazal 1500; p < 0,01, temporal 500; p < 0,01,temporal 1500; p < 0,01). Hasta grubunda subfoveal ortalama koroid kalınlığı 319,2 ± 79,4 idi, kontrol grubunda ise 270.3 ± 102.4 idi. Nazal 500 noktasında 314,3 ± 84,7’a karşılık 253,7 ± 94,8, nazal 1500 noktasında 288 ± 90,1’a karşılık 219,8 ± 84,4, temporal 500 noktasında 313,9 ± 76,1’a karşılık 254,4 ± 90,9 ve temporal 1500 noktasında 288,6 ± 61,3’a karşılık 240,9 ± 90,7 idi.

Sonuç: Submaküler koroidin kalınlaşması hidroksiklorokinin koroidal melanositlerde birikmesine ve çevre dokudaki reksiyona bağlı olabilir. Bu hipotezin doğrulanabilmesi için deneysel çalışmalar gerekmektedir.

Anahtar Kelimeler

• hidroksiklorokin
• koroid kalınlığı
• ooptik koherens tomografi

Choroidal Thickness in Patients Using Hydroxychloroquine Without Retinal Toxicity

Öz

Objective: Hydroxychloroquine is a well-known antirheumatic drug that may cause irreversible retinal damage if not detected earlier. However, to date, there has been no study investigating the effects of hydroxychloroquine on the choroid. In this study, we evaluated the submacular choroidal thickness in patients using hydroxychloroquine without retinal toxicity in comparison to healthy controls.

Material and Method: Thirty patients using hydroxychloroquine, and thirty-nine healthy controls were included in this study. Only the right eyes of the patients and the control subjects were used in the analysis. The demographic features of the patients and control subjects were recorded. Each subject underwent ophthalmological examinations including refraction, visual acuity, intraocular pressure, 10/2 visual field testing, slit-lamp biomicroscopy, and fundus examination. As the last step submacular choroid was imaged by enhanced depth imaging optical coherence tomography (EDI-OCT), and measured manually at five regions (subfoveal, nasal 500, nasal 1500, temporal 500 and temporal 1500).

Results: There were no significant differences between patients and controls regarding age, gender, intraocular pressure, best-corrected visual acuity (p>0,05). Choroidal thickness values at all regions were statistically higher in patients than controls (subfoveal; p < 0.05, nasal 500; p < 0.01, nasal 1500; p < 0.01, temporal 500; p < 0.01,temporal 1500; p < 0.01). The mean of the subfoveal choroidal thickness is 319.2 ± 79.4 in patients and 270.3 ± 102.4 in controls. It is 314.3 ± 84.7 vs 253.7 ± 94.8 for nasal 500, 288 ± 90.1 vs 219.8 ± 84.4 for nasal 1500, 313.9 ± 76.1 vs 254.4 ± 90.9 for temporal 500 and 288.6 ± 61.3 vs 240.9 ± 90.7 for temporal 1500.

Conclusion: Thickening in submacular choroid could be due to the accumulation of these drugs in the choroidal melanocytes and reactions from the surrounding tissues.

Anahtar Kelimeler

• Hydroxychloroquine
• choroidal thickness
• optical coherence tomography

Kaynakça

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