Abstract
Purpose:
To evaluate feasibility, sensitivity and correlations between the four priority tests in the early diagnosis of retinal toxicity secondary to PT.
Methods:
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.
Results:
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.
Conclusions:
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.
Keywords: 688 retina •
550 imaging/image analysis: clinical •
509 electroretinography: clinical