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Advisor(s)
Abstract(s)
A toxicidade retiniana provocada pela Hidroxicloroquina, fármaco usado no tratamento do Lupus Eritematoso Sistémico (LES) e da Artrite Reumatóide (AR), está associada a perda de visão grave e progressiva. Dado que as lesões iniciais podem ser revertidas após a suspensão do fármaco, é de extrema importância a observação oftalmológica regular e a avaliação do campo visual.
Deste modo, com a realização deste trabalho pretende-se avaliar a função retiniana de doentes que realizam tratamento contínuo com Hidroxicloroquina através da Microperimetria e verificar a sensibilidade do teste em detetar sinais precoces de toxicidade retiniana.
Trata-se de um estudo retrospetivo que incluiu doentes com LES/AR, sob tratamento contínuo com Hidroxicloroquina, e que realizaram Microperimetria. Os resultados foram comparados com um grupo controlo ajustado à idade. A sensibilidade e especificidade deste teste perimétrico para a deteção precoce de retinotoxicidade foi também avaliado e comparado com a sensibilidade e especificidade demonstrada pela perimetria standard.
O grupo de doentes incluiu 323 olhos (idade 48.61 + 14.41 anos, AV = 0.95 + 0.09, tempo de tratamento 77.50 + 70.31 meses), e o grupo controlo incluiu 250 olhos (idade 49.49 + 9.59 anos, AV = 0.98 + 0.05). Foram encontradas diferenças estatisticamente significativas entre os dois grupos de estudo para a sensibilidade global e dos três anéis da Microperimetria (p<0.0001, para todas as áreas), sendo o grupo de doentes a
apresentar valores de sensibilidade mais baixos. A Microperimetria (sensibilidade global) apresentou 92.55% de sensibilidade para 84.62% de especificidade, enquanto a perimetria convencional apresentou 57.76% de sensibilidade para 76.92% de especificidade.
A Microperimetria revela ser mais sensível na deteção precoce de toxicidade retiniana por Hidroxicloroquina, comparando com a Perimetria convencional, pelo que deve ser considerada como um potencial biomarcador.
Retinal toxicity caused by Hydroxychloroquine, a drug used to treat Systemic Lupus Erythematosus (SLE) and Rheumatoid Arthritis (RA), is associated with severe and progressive vision loss. Because initial lesions can be reversed after drug discontinuation, regular ophthalmologic observation and visual field assessment are of paramount importance. Therefore, the aim of this study is to evaluate the retinal function of patients who undergo continuous treatment with Hydroxychloroquine through Microperimetry and to verify the sensitivity of the test to detect early signs of retinal toxicity. This is a retrospective study that included patients with SLE/RA, under continuous treatment with Hydroxychloroquine, who performed Microperimetry. The results were compared with an age-related control group. The sensitivity and specificity of this perimetric test for the early detection of retinotoxicity was also evaluated and compared with the sensitivity and specificity demonstrated by standard perimetry. The group of patients included 323 eyes (age 48.61 + 14.41 years, VA = 0.95 + 0.09, treatment duration 77.50 + 70.31 months), and the control group included 250 eyes (age 49.49 + 9.59 years, VA = 0.98 + 0.05). Statistically significant differences were found between the two study groups for overall sensitivity and the three microperimetric rings (p<0.0001 for all areas), having patient group the lowest sensitivity. Microperimetry (overall sensitivity) presented 92.55% sensitivity to 84.62% specificity, while conventional perimetry presented 57.76% sensitivity to 76.92% specificity. Microperimetry reveals to be more sensitive in the early detection of retinal toxicity by Hydroxychloroquine, compared with conventional perimetry, and should therefore be considered as a potential biomarker.
Retinal toxicity caused by Hydroxychloroquine, a drug used to treat Systemic Lupus Erythematosus (SLE) and Rheumatoid Arthritis (RA), is associated with severe and progressive vision loss. Because initial lesions can be reversed after drug discontinuation, regular ophthalmologic observation and visual field assessment are of paramount importance. Therefore, the aim of this study is to evaluate the retinal function of patients who undergo continuous treatment with Hydroxychloroquine through Microperimetry and to verify the sensitivity of the test to detect early signs of retinal toxicity. This is a retrospective study that included patients with SLE/RA, under continuous treatment with Hydroxychloroquine, who performed Microperimetry. The results were compared with an age-related control group. The sensitivity and specificity of this perimetric test for the early detection of retinotoxicity was also evaluated and compared with the sensitivity and specificity demonstrated by standard perimetry. The group of patients included 323 eyes (age 48.61 + 14.41 years, VA = 0.95 + 0.09, treatment duration 77.50 + 70.31 months), and the control group included 250 eyes (age 49.49 + 9.59 years, VA = 0.98 + 0.05). Statistically significant differences were found between the two study groups for overall sensitivity and the three microperimetric rings (p<0.0001 for all areas), having patient group the lowest sensitivity. Microperimetry (overall sensitivity) presented 92.55% sensitivity to 84.62% specificity, while conventional perimetry presented 57.76% sensitivity to 76.92% specificity. Microperimetry reveals to be more sensitive in the early detection of retinal toxicity by Hydroxychloroquine, compared with conventional perimetry, and should therefore be considered as a potential biomarker.
Description
Trabalho realizado para a obtenção do Título de Especialista na área de Tecnologias de Diagnóstico e Terapêutica – Ortóptica
Keywords
Hidroxicloroquina Função retiniana Lupus Eritematoso Sistémico (LES Artrite Reumatóide (AR) Microperimetria