Avaliação da frequência da retinopatia tóxica por antimaláricos em pacientes com artrite reumatoide e lúpus eritematosos através da tomografia de coerência óptica de domínio espectral (SD-CT)

Abstract

The Objective of this research was to evaluate the frequency of toxic retinopathy and adherence to treatment of patients with Systemic Lupus Erythematosus (LE) and Rheumatoid Arthritis (RA) in chronic use of chloroquine diphosphate (CQ) or hydroxychloroquine (HCQ) by coherence tomography examination optical spectral domain (SD-OCT) and a questionnaire consisting of 11 questions, correlating the findings with the examination of visual acuity (Snellen chart), the color vision test (Ishirara table) and fundoscopy under mydriasis. This is a cross-sectional study assessing patients using CQ or HCQ regular for a period less than one year. Patients completed a questionnaire about opinion and regular use of antimalarials, underwent clinical ophthalmological examination and SD-OCT. Of the 300 patients evaluated, 217 were eligible. The prevalence of toxic maculopathy by antimalarial detected by the SD-OCT examination in the study population was 4.15% (9 of 217 patients). The prevalence of specific QC was 7.4% (4 of 54) for HCQ 0.82% (1 121), by both medications from 9.52% (4 of 42) patients who used first to CQ that was replaced by HCQ. Only patients with maculopathy in advanced stages (moderate and severe), considered irreversible, showed changes in clinical tests: color vision test changed in 11.1% (1 of 9), visual acuity changed in 33.3% (3 9) and fundoscopy under mydriasis changed in 33.3% (3 of 9) patients. The SD-OCT was essential for the diagnosis of toxic maculopathy by antimalarial in early stages (premacular and early macular), present in 6 of the 9 patients with the following characteristics: asymptomatic in regular use of antimalarial drugs, particularly chloroquine, seven days the week, for a longer period than five years, mainly to use for more than 10 years with normal clinical ophthalmological examination antimalarials have good tolerance by users who consider it a good medication. Only 31% of users reported some symptom during treatment. More than half (57%) found it good because they held their disease and 24% reported being afraid to use it, but used it as prescribed. The fear is still a factor that hinders adherence to treatment with antimalarial drugs. The SD-OCT was helpful to demystify the false toxic effects of antimalarial medication and identify early signs of maculopathy. Diagnosis at an early stage avoid visual damage or, if present, visual recovery may be possible with discontinuation of medication antimalarial.