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Inna Glybina; Multifocal Electroretinography (mfERG), Spectral-Domain Optical Coherent Tomography (SD-OCT), Fundus Autofluorescence (FAF) and Humphrey Visual Fields (HVF) in Patients with Retinal Toxicity Secondary to Plaquenil Therapy (PT). Invest. Ophthalmol. Vis. Sci. 2013;54(15):3853.
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© ARVO (1962-2015); The Authors (2016-present)
To evaluate feasibility, sensitivity and correlations between the four priority tests in the early diagnosis of retinal toxicity secondary to PT.
A retrospective analysis of testing results of 64 patients (56 females, 8 males), aged 21-79 years, with diagnosed retinal toxicity secondary to PT, was performed. Visual acuity (VA) varied from 20/20 to 20/200. Duration of PT was from 2 to 32 years. Out of these 64 patients, all were tested with mfERG; 43 had HVF (10-2 protocol); 42 had SD-OCT (macula protocol); 36 had FAF. Results were analyzed quantitatively using standardized protocols. Sensitivity of the tests and correlations of findings were evaluated.
Fundus pigmentary abnormalities were observed in 66.1% of the examined eyes and did not correlate with VA or duration of PT. MfERG showed changes in concentric ring ratios in 73.5% of the eyes, which had moderate correlation with VA. The mfERG changes showed different patterns of depression: classical isolated annular pericentral depression without foveal depression was seen in 27.4% of the eyes; incomplete pericentral depression with or without foveal depression was seen in 32.8% of the eyes; combination of pericentral and foveal depression was seen in 70.2% of the eyes; presence of peripheral sectoral depression was seen in 46.1% of the eyes and generalized depression was seen in 21.9% of the eyes. HVF showed changes is 33.6% of the eyes with moderate correlation with VA. SD-OCT showed disrupted outer-inner photoreceptor segment junction (OS/IS) with or without photoreceptor atrophy in 54.7% of the eyes and correlated mildly with VA or duration of PT. FAF was abnormal bilaterally in 30% of the eyes and did not correlate with duration of therapy. Changes in all four tests were observed in 16.7% of the examined eyes. The best correlation was seen between the mfERG and SD-OCT. Changes of minimum two types of testing were seen in each patient.
Our results show that all four tests provide valuable information in the diagnosis of early plaquenil toxicity and complement each other, however, mfERG and SD-OCT seem to be affected the earliest, whereas changes of HVF and FAF develop later.
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