Neubauer A S, Samari-Kermani K, Schaller U, Welge-Lübetaen U, Rudolph G, Berninger T
Department of Ophthalmology, Ludwig-Maximilians-Universität, Munich, Germany.
Br J Ophthalmol. 2003 Jul;87(7):902-8. doi: 10.1136/bjo.87.7.902.
To investigate the relative sensitivity and specificity of two tests of retinal function (the electro-oculogram (EOG) and a computerised colour vision test) in screening for ocular toxicity caused by chloroquine and hydroxychloroquine.
93 patients with rheumatic diseases receiving long term chloroquine and hydroxychloroquine therapy were followed for an average of 2.6 years. Clinical examination, an EOG, and a quantitative test of colour vision were carried out every 6 months.
Mild fundus changes were observed in 38 patients. Four patients developed typical bull's eye maculopathy, three of whom had received 250, 365, and 550 g total dose of chloroquine, and one 1500 g of hydroxychloroquine. Statistical analysis of all patients showed that for those with no fundus changes or stippled pigmentation a number showed elevation of tritan threshold, so that if macular stippling is a sign of mild retinopathy the test on tritan changes has a 64% sensitivity and 63% specificity for an upper threshold value of 7%. All four patients with bull's eye lesions showed a marked disturbance of tritan colour vision, with a threshold of 14.8%, a sensitivity of 75%, and a specificity of 94%. For protan colour vision a threshold of 10% gives 75% sensitivity and 91% specificity. By contrast, neither an absolute nor a relative EOG reduction was a valid criterion for early or late chloroquine retinopathy. In advanced retinopathy an Arden coefficient (AQ) <180% yields 50% sensitivity and 54% specificity. When AQ <160% is the threshold, sensitivity does not increase but specificity rises to 82%. Occurrence of marked corneal deposits on clinical examination yields 50% sensitivity and 90% specificity in this situation.
Screening for chloroquine retinopathy can be improved by using a sensitive colour test. Disturbance of the tritan axis appears to occur first. A normal test result on computerised colour testing virtually excludes any retinopathy by antimalarials. The EOG is of little diagnostic value.
研究两种视网膜功能测试（眼电图（EOG）和计算机化色觉测试）在筛查氯喹和羟氯喹所致眼毒性方面的相对敏感性和特异性。
对93例接受长期氯喹和羟氯喹治疗的风湿性疾病患者进行了平均2.6年的随访。每6个月进行一次临床检查、眼电图检查和色觉定量测试。
38例患者观察到轻度眼底改变。4例患者出现典型的靶心状黄斑病变，其中3例接受的氯喹总剂量分别为250、365和550克，1例接受的羟氯喹剂量为1500克。对所有患者的统计分析表明，对于那些没有眼底改变或点状色素沉着的患者，一些患者的蓝黄色阈值升高，因此，如果黄斑点状沉着是轻度视网膜病变的一个体征，那么对于蓝黄色变化的测试，当阈值上限为7%时，敏感性为64%，特异性为63%。所有4例靶心状病变患者均表现出明显的蓝黄色觉障碍，阈值为14.8%，敏感性为75%，特异性为94%。对于红色觉，阈值为10%时，敏感性为75%，特异性为91%。相比之下，无论是绝对还是相对的眼电图降低都不是早期或晚期氯喹视网膜病变的有效标准。在晚期视网膜病变中，阿登系数（AQ）<180%时，敏感性为50%，特异性为54%。当AQ<160%为阈值时，敏感性没有增加，但特异性升至82%。在这种情况下，临床检查出现明显角膜沉着时，敏感性为50%，特异性为90%。
使用敏感的色觉测试可改善氯喹视网膜病变的筛查。蓝黄色轴的障碍似乎最先出现。计算机化色觉测试结果正常实际上可排除抗疟药所致的任何视网膜病变。眼电图的诊断价值不大。
