Scarinci Fabio, Shaarawy Amr, Narala Ramsudha, Jampol Lee M, Fawzi Amani A
*Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois;†G.B. Bietti Eye Foundation-IRCCS, Rome, Italy;‡Department of Ophthalmology, Alexandria Faculty of Medicine, Alexandria, Egypt; and§Department of Ophthalmology, Kresge Eye Institute, Detroit Medical Center, Detroit, Michigan.
Retina. 2016 Oct;36(10):1951-1957. doi: 10.1097/IAE.0000000000001217.
To quantify external limiting membrane (ELM) disruption and photoreceptor volume over time, using spectral domain optical coherence tomography in eyes with hydroxychloroquine (HCQ) toxic effects after discontinuation.
We performed a retrospective chart review of patients who were screened for toxic effects of HCQ between January 1, 2009 and August 31, 2014, and identified 10 patients diagnosed as having HCQ retinal toxic effects. Intact ELM and the Bruch membrane were manually traced using ImageJ software and their lengths from each scan of the spectral domain optical coherence tomography macular volume were summed. The ratio of intact ELM length/Bruch membrane length was calculated. We measured the two-dimensional photoreceptor area between the intact ELM and Bruch membrane in every cross-sectional B-scan. We calculated the total volume of photoreceptors in a volumetric OCT by multiplying photoreceptor area by the distance between B-scans.
Of the 10 patients (120 eyes), 1 eye was excluded because of the presence of vitreomacular traction. The mean cumulative dose of HCQ was 1,951 g (range, 584-3,650 g). The mean follow-up duration was 34.1 months (range, 11-64 months). Based on the extent of ELM integrity at diagnosis of HCQ toxicity, we classified eyes into 2 groups: 1) 12 eyes showed severe ELM disruption and 2) 7 eyes had intact ELM. All 19 eyes showed characteristic signs of HCQ toxicity on the visual field examination at the baseline. Seven of 12 eyes with ELM disruption showed progressive ELM changes, including 7 eyes that additionally developed progressive photoreceptor volume decline, whereas 5 eyes remained stable. All 7 eyes with intact ELM remained stable over time.
Intact ELM status at the time of HCQ discontinuation is a good prognostic sign, and ELM status may allow clinicians to predict patients at risk for progression of retinopathy. Quantitative measurements of ELM disruption and photoreceptors volume may provide an objective tool to monitor outer retinal changes due to HCQ.
使用光谱域光学相干断层扫描技术，对停用羟氯喹（HCQ）后出现毒性作用的眼睛，随时间推移量化其外部限制膜（ELM）破坏情况和光感受器体积。
我们对2009年1月1日至2014年8月31日期间接受HCQ毒性筛查的患者进行了回顾性病历审查，确定了10例被诊断为患有HCQ视网膜毒性的患者。使用ImageJ软件手动追踪完整的ELM和布鲁赫膜，并将它们在光谱域光学相干断层扫描黄斑体积每次扫描中的长度相加。计算完整ELM长度与布鲁赫膜长度的比值。我们在每个横断面B扫描中测量完整ELM和布鲁赫膜之间的二维光感受器面积。通过将光感受器面积乘以B扫描之间的距离，计算体积性光学相干断层扫描中光感受器的总体积。
10例患者（120只眼）中，1只眼因存在玻璃体黄斑牵引而被排除。HCQ的平均累积剂量为1951克（范围584 - 3650克）。平均随访时间为34.1个月（范围11 - 64个月）。根据HCQ毒性诊断时ELM完整性的程度，我们将眼睛分为两组：1）12只眼显示严重ELM破坏，2）7只眼ELM完整。所有19只眼在基线视野检查时均显示HCQ毒性的特征性体征。12只ELM破坏的眼中，7只显示ELM逐渐变化，其中7只还出现光感受器体积逐渐下降，而5只眼保持稳定。所有7只ELM完整的眼随时间保持稳定。
停用HCQ时ELM完整状态是一个良好的预后指标，ELM状态可能使临床医生能够预测有视网膜病变进展风险的患者。ELM破坏和光感受器体积的定量测量可能为监测HCQ引起的视网膜外层变化提供一种客观工具。
