Jaumouillé S, Espargillière D, Mouriaux F, Mortemousque B
Service d'ophtalmologie, CHU de Rennes, 2, rue Henri-le-Guilloux, 35000 Rennes, France.
Service d'ophtalmologie, CHU de Rennes, 2, rue Henri-le-Guilloux, 35000 Rennes, France.
J Fr Ophtalmol. 2015 May;38(5):377-87. doi: 10.1016/j.jfo.2015.01.005. Epub 2015 Apr 24.
To compare the results, in clinical practice, of screening procedures for hydoxychloroquine retinopathy, according to the new recommendations of the American Academy of Ophthalmology of 2011.
Hundred and eighty-four patients on long-term hydroxychloroquine underwent ophthalmologic evaluation, including fundus examination, 10.2 automated visual field, fundus autofluorescence, SD-OCT optical coherence tomography, and multifocal ERG, whenever possible, in a prospective monocentric study.
There was a significant correlation (P<0.05) between cumulative HCQ dose and positive results on SD-OCT and 10.2 visual field. There were no significant correlations between high cumulative HCQ dose and positive results for fundus examination, autofluorescence, or multifocal ERG. Average cumulative doses between the healthy group (946g) and the maculopathy group (1427g) were significantly different (P<0.05). Out of 184 patients, 12 toxic maculopathies were found (prevalence 6.5%). For these 12 cases, 5 were diagnosed at clinical stages, and 7 were diagnosed in the early preclinical stage. Ten patients had positive visual fields, and 8 patients had pathological SD-OCT signs. Autofluorescence was affected in the clinical stage, but not in the preclinical stage. In four out of the twelve cases of maculopathy, patients had pathological ERG results.
The significant correlation between cumulative HCQ dose, considered as the main risk factor for maculopathy, and positive SD-OCT and 10.2 visual field results render the combination of these two tests the basis of the screening strategy for plaquenil maculopathy. These results suggest using a simplified screening procedure, including annual SD-OCT and 10.2 visual field while taking the cumulative dose into account. Multifocal ERG seems more helpful for diagnostic confirmation than screening, especially for the preclinical stage. Fundus autofluorescence is not an efficient test for early diagnosis.
根据美国眼科学会2011年的新建议，比较在临床实践中羟氯喹视网膜病变筛查程序的结果。
在一项前瞻性单中心研究中，对184例长期服用羟氯喹的患者进行眼科评估，尽可能包括眼底检查、10.2自动视野检查、眼底自发荧光、SD-OCT光学相干断层扫描和多焦视网膜电图。
累积羟氯喹剂量与SD-OCT和10.2视野检查的阳性结果之间存在显著相关性（P<0.05）。高累积羟氯喹剂量与眼底检查、自发荧光或多焦视网膜电图的阳性结果之间无显著相关性。健康组（946克）和黄斑病变组（1427克）的平均累积剂量有显著差异（P<0.05）。在184例患者中，发现12例中毒性黄斑病变（患病率6.5%）。对于这12例病例，5例在临床阶段被诊断，7例在临床前早期阶段被诊断。10例患者视野检查阳性，8例患者SD-OCT有病理体征。自发荧光在临床阶段受到影响，但在临床前阶段未受影响。在12例黄斑病变病例中的4例中，患者视网膜电图结果异常。
累积羟氯喹剂量被视为黄斑病变的主要危险因素，与SD-OCT和10.2视野检查的阳性结果之间的显著相关性使得这两项检查的联合成为羟氯喹黄斑病变筛查策略的基础。这些结果表明应采用简化的筛查程序，包括每年进行SD-OCT和10.2视野检查并考虑累积剂量。多焦视网膜电图似乎对诊断确认比对筛查更有帮助，尤其是对于临床前阶段。眼底自发荧光不是早期诊断的有效检查方法。
