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Inna V Glybina, ; Multifocal Electroretinography (mfERG), Spectral-Domain Optical Coherent Tomography (SD-OCT), Fundus Autofluorescence (FAF) and Humphrey Visual Fields (HVF) in Early Detection of Plaquenil Toxicity.. Invest. Ophthalmol. Vis. Sci. 2014;55(13):1143.
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To evaluate feasibility, sensitivity and correlations between the four priority tests in the early diagnosis of retinopathy due to plaquenil therapy (PT).
A retrospective analysis of testing results of 64 patients (56 females, 8 males), aged 21-79 years, diagnosed with retinal toxicity secondary to PT, was performed. Visual acuity (VA) varied from 20/20 to 20/200. Duration of PT was from 3 to 32 years. Out of these 64 patients, all 64 were tested with mfERG, 43 had HVF (10-2), 42 had SD-OCT, 36 had FAF. Results were analyzed quantitatively using standardized protocols. Statistical analysis of the findings was performed.
Fundus pigmentary abnormalities were observed in 66.1% of eyes and did not correlate with VA or duration of PT. MfERG showed changes in concentric ring ratios in 81 eyes (47 patients, 73.5%), which had moderate correlation with VA. The mfERG changes showed different patterns of depression: annular pericentral depression without foveal depression was seen in 35 eyes (21 patients, 27.4%); incomplete pericentral depression with or without foveal depression was seen in 42 eyes (27 patients, 32.8%); combination of pericentral and foveal depression was seen in 87 eyes (47 patients, 70.2%); presence of peripheral sectoral depression was seen in 59 eyes (34 patients, 46.1%) and generalized depression was seen in 28 eyes (16 patients, 21.9%). HVF showed changes is 43 eyes (24 patients, 33.6%) with moderate correlation with VA. SD-OCT showed disrupted outer-inner photoreceptor segment junction (OS/IS) with or without photoreceptor atrophy in 36 eyes (18 patients, 28.1%) and correlated mildly with VA or duration of PT. FAF was abnormal bilaterally in 30 patients 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 the tests provide valuable information in the diagnosis of early plaquenil toxicity and complement each other, however, mfERG and FAF seem to be affected the earliest.
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