Klin Monbl Augenheilkd 2019; 236(07): 901-906
DOI: 10.1055/a-0651-0657
Klinische Studie
Georg Thieme Verlag KG Stuttgart · New York

Ergebnisse spektraler optischer Kohärenztomografie bei den mit Chloroquin behandelten Patienten mit systemischem Lupus erythematodes

Spectral Domain Optical Coherence Tomographic Findings in Systemic Lupus erythematosus in Patients Treated with Chloroquine
Nina Kosic Knez
1   Department of Ophthalmology, University Clinical Centre Maribor, Maribor, Slovenia
,
Katarina Šiško
1   Department of Ophthalmology, University Clinical Centre Maribor, Maribor, Slovenia
2   Faculty of Medicine, University of Maribor, Maribor, Slovenia
,
Iztok Holc
2   Faculty of Medicine, University of Maribor, Maribor, Slovenia
3   Department of Rheumathology and Immunology, University Clinical Centre Maribor, Maribor, Slovenia
,
Dusica Pahor
1   Department of Ophthalmology, University Clinical Centre Maribor, Maribor, Slovenia
2   Faculty of Medicine, University of Maribor, Maribor, Slovenia
,
Artur Pahor
2   Faculty of Medicine, University of Maribor, Maribor, Slovenia
3   Department of Rheumathology and Immunology, University Clinical Centre Maribor, Maribor, Slovenia
,
Tomaz Gracner
1   Department of Ophthalmology, University Clinical Centre Maribor, Maribor, Slovenia
2   Faculty of Medicine, University of Maribor, Maribor, Slovenia
› Author Affiliations
Further Information

Publication History

eingereicht 29 January 2018

akzeptiert 10 June 2018

Publication Date:
24 October 2018 (online)

Zusammenfassung

Ziel Das Ziel unserer Studie war es, mögliche Netzhautveränderungen bei den mit Chloroquinphosphat behandelten SLE-Patienten (SLE: systemischer Lupus erythematodes) festzustellen und zwar in Bezug auf die Behandlungsdauer.

Methoden In die Studie wurden 41 SLE-Patienten (82 Augen) eingeschlossen, die mit Chloroquinphosphat oder Hydroxychloroquinphosphat behandelt werden und bei denen noch keine Netzhautpathologie diagnostiziert worden ist. Studienteilnehmende wurden entsprechend der Behandlungsdauer in 2 Gruppen eingeteilt. Die 1. Gruppe umfasste 18 Patienten (36 Augen), die einer bis zu 5-jährigen Behandlung unterzogen wurden, und die 2. Gruppe bestand aus 23 Patienten (46 Augen), die von 5 – 20 Jahren behandelt wurden. Es wurde eine gründliche Augenuntersuchung durchgeführt, einschließlich bestkorrigierter Sehschärfe, Farbsehen, Gesichtsfelduntersuchung, Fundusuntersuchung bei dilatierten Pupillen, Autofluoreszenzuntersuchung, Fundusfotografie und Spectral-Domain optische Kohärenztomografie (SD-OCT).

Ergebnisse Die durchschnittliche Behandlungsdauer der 1. Gruppe betrug 2,79 ± 1,37 Jahre, während die 2. Gruppe im Durchschnitt 8,67 ± 2,26 Jahre behandelt wurde. Der Unterschied in der zentralen Netzhautdicke zwischen den beiden Gruppen war statistisch insignifikant (p > 0,05). Der Vergleich der parafovealen Dicke zwischen den beiden Gruppen war in allen Regionen statistisch insignifikant (p > 0,05). Gesichtsfelduntersuchung, Autofluoreszenzuntersuchung und Fundusfotografie waren ohne nennenswerte Pathologie.

Schlussfolgerung Unsere Ergebnisse zeigen keine statistisch signifikanten Veränderungen in der Netzhautstruktur zwischen den beiden Gruppen und in Bezug auf die Behandlungsdauer. Infolgedessen kann man schließen, dass jährliche Nachuntersuchungen dieser Patienten sicher genug sind, um mögliche präklinische Makulopathie festzustellen.

Abstract

Purpose To recognise possible retinal changes in patients with SLE treated with chloroquine phosphate, as depending on the duration of treatment.

Methods The study included 41 patients (82 eyes) who received treatment for SLE with chloroquine or hydroxychloroquine phosphate and had not previously been diagnosed with retinal pathology. Participants were divided into two groups according to the duration of treatment. The first group included 18 patients (36 eyes) treated for up to five years and the second group consisted of 23 patients (46 eyes) treated from five to twenty years. We performed a thorough eye exam, including best-corrected visual acuity, colour vision, visual field examination, dilated fundus examination, autofluorescence imaging, color fundus photography and spectral domain optical coherence tomography.

Results Mean duration of treatment in the first group was 2.79 ± 1.37 years, and in the second group 8.67 ± 2.26 years. The difference in central retinal thickness between the two groups was not statistically significant (p > 0.05). Comparison of parafoveal thickness between the two groups was statistically non-significant in all quadrants (p > 0.05). Visual field examination, autofluorescence images and colour fundus photographs were without noteworthy pathology.

Conclusion Our results indicate that there were no significant changes in retinal structure between groups that depended on the duration of treatment. Hence, we can conclude that a yearly follow-up of these patients is sufficient to discover possible preclinical maculopathy.

 
  • Literatur

  • 1 Felson DT, Anderson JJ, Meenan RF. The comparative efficacy and toxicity of second-line drugs in rheumatoid arthritis results of two metaanalyses. Arthritis Rheum 1990; 33: 1449-1461
  • 2 Szostakiewicz-Grabek B, Juszkiewicz-Borowiec M, Krasowska D. [The effect of drugs used in treatment of skin disorders on visual system]. Pol Merkur Lekarski 2016; 40: 269-272
  • 3 Ding HJ, Denniston AK, Rao VK. et al. Hydroxichloroquine-related retinal toxicity. Rheumatology 2016; 55: 957-967
  • 4 Yusuf IH, Sharma S, Luqmani R, Downes SM. Hydroxychloroquine retinopathy. Eye (Lond) 2017; 31: 828-845
  • 5 Espandar G, Moghimi J, Ghorbani R. et al. Retinal toxicity in patients treated with hydroxychloroquine: A cross-sectional study. Med Hypothesis Discov Innov Ophthalmol 2016; 5: 41-46
  • 6 Wallace DJ. Advances in drug therapy for systemic lupus erythematosus. BMC Med 2010; 8: 77
  • 7 Marmor MF, Kellner U, Lai TY. et al. Revised recommendations on screening for chloroquine and hydroxychloroquine retinopathy. Ophthalmology 2011; 118: 415-422
  • 8 Farrell DF. Retinal toxicity to antimalarial drugs: chloroquine and hydroxychloroquine: a neurophysiologic study. Clin Ophthalmol 2012; 6: 377-383
  • 9 Schroeder RL, Gerber JP. Chloroquine and hydroxichloroquine binding to melanin: Some possible consequences for pathologies. Toxicol Rep 2014; 1: 963-968
  • 10 Allam RS, Abd-Elmohsen MN, Khafagy MM. et al. Spectral-Domain Optical Coherence Tomography of Preclinical Chloroquine Maculopathy in Egyptian Rheumatoid Arthritis Patients. J Ophthalmol 2015; 2015: 292357 doi:10.1155/2015/292357
  • 11 Gerding H. Chloroquine retinopathy under inadequately weight adjusted dosage: early detection by multimodal imaging. Klin Monatsbl Augenheilkd 2017; 234: 543-545
  • 12 Pasadhika S, Fishman G. Effects of chronic exposure to hydroxychloroquine or chloroquine on inner retinal structures. Eye (Lond) 2010; 24: 340-346
  • 13 Rodriquezz-Padilla JA, Hedges TR, Monson B. et al. High-speed ultra-high-resolution optical coherence tomography findings in hydroxychloroquine retinopathy. Arch Ophthalmol 2007; 125: 775-780
  • 14 Motarjamizadeh Q, Aidenloo NS, Abbaszadeh M. Detection of hydroxychloroquine retinal toxicity by automated perimetry in 60 rheumatoid arthritis patients with normal fundoscopic findings. Glob J of Health Sci 2016; 8: 59-64
  • 15 Pandya HK, Robinson M, Mandal N. et al. Hydroxychloroquine retinopathy: A review of imaging. Indian J Ophthalmol 2015; 63: 570-574
  • 16 Marmor MF, Kellner U, Lai TY. et al. Recommendations on Screening for Chloroquine and Hydroxychloroquine Retinopathy (2016 Revision). Ophthalmology 2016; 123: 1386-1394
  • 17 Kim JW, Kim YY, Lee H. et al. Risk of retinal toxicity in longterm users of hydroxychloroquine. J Rheumatol 2017; 44: 1674-1679
  • 18 Dammacco R. Systemic lupus erythematosus and ocular involvement: an overview. Clin Exp Med 2018; 18: 135-149 doi:10.1007/s10238-017-0479-9
  • 19 Cukras C, Huynh N, Vitale S. et al. Subjective and objective screening tests for hydroxychloroquine toxicity. Ophthalmology 2015; 122: 356-366
  • 20 Wallace DJ. The history of antimalarials. Lupus 1996; 5 (Suppl. 01) S2-S3
  • 21 Stelton CR, Connors DB, Wallia SS. et al. Hydrochloroquine retinopathy: characteristic presentation with review of screening. Clin Rheumatol 2013; 32: 895-898
  • 22 Yam JCS, Kwok AKH. Ocular toxicity of hydroxychloroquine. Hong Kong Med J 2006; 12: 294-304
  • 23 Geamanu Panca A, Popa-Cherecheanu A, Marinescu B. et al. Retinal toxicity associated with chronic exposure to hydroxychloroquine and its ocular screening. Review. J Med Life 2014; 7: 322-326
  • 24 Bergholz J, Schroeter J, Ruther K. Evaluation of risk factors for retinal damage due to chloroquine and hydroxychloroquine. Br J Ophthalmol 2010; 94: 1637-1642
  • 25 Mavrikakis I, Sfikakis PP, Mavrikakis E. et al. The incidence of irreversible retinal toxicity in patients treated with hydroxychloroquine: a reappraisal. Ophthalmology 2003; 110: 1321-1326
  • 26 Wolfe F, Marmor MF. Rates and predictors of hydroxychloroquine retinal toxicity in patients with rheumatoid arthritis and systemic lupus erythematosus. Arthritis Care Res (Hoboken) 2010; 62: 775-784
  • 27 Telek HH, Yesilirmak N, Sungur G. et al. Retinal toxicity related to hydroxychloroquine in patients with systemic lupus erythematosus and rheumatoid arthritis. Doc Ophthalmol 2017; 135: 187-194
  • 28 Jordan P, Brookes JG, Nikolic G, Le Couteur DG. Hydroxychloroquine overdose: toxicokinetics and management. J Toxicol Clin Toxicol 1999; 37: 861-864
  • 29 Shroyer NF, Lewis RA, Lupski JR. Analysis of the ABCR [ABCA4] gene in 4-aminoquinoline retinopathy: is retinal toxicity by chloroquine and hydroxychloroquine related to Stargardtʼs disease. Am J Ophthalmol 2001; 131: 761-766
  • 30 Wang C, Fortin PR, Li Y. et al. Discontinuation of antimalarial drugs in systemic lupus erythematosus. J Rheumatol 1999; 26: 808-815
  • 31 Costedoat-Chalumeau N, Amoura Z, Hulot JS. et al. Very low blood hydroxychloroquine concentration as an objective marker of poor adherence to treatment of systemic lupus erythematosus. Ann Rheum Dis 2007; 66: 821-824
  • 32 Costedoat-Chalumeau N, Pouchot J, Guettrot-Imbert G. et al. Adherence to treatment in systemic lupus erythematosus patients. Best Pract Res Clin Rheumatol 2013; 27: 329-340
  • 33 Reed H, Karlinsky W. Delayed onset of chloroquine retinopathy. Can Mes Assoc J 1967; 97: 1408-1411