Latasiewicz M, Gourier H, Yusuf I H, Luqmani R, Sharma S M, Downes S M
Oxford Eye Hospital, John Radcliffe Hospital, Oxford, UK.
Department of Rheumatology, Nuffield Orthopaedic Centre, Oxford, UK.
Eye (Lond). 2017 Jun;31(6):972-976. doi: 10.1038/eye.2016.297. Epub 2017 Feb 10.
PurposeThe aim of this case series is to raise awareness of the emerging issue of serious retinal damage caused by the prolonged use of hydroxychloroquine (HCQ) and the importance of adequate and appropriate monitoring of visual function during treatment.Patient and methodsThis is a small retrospective case series of 3 patients on long-term HCQ who developed serious symptomatic retinal toxicity confirmed on imaging and functional testing.ResultsAll 3 patients were treated with HCQ for over 15 years; two for rheumatoid arthritis (RA), and the third for systemic lupus erythematosus (SLE). All 3 patients had macular involvement varying in severity confirmed with characteristic features on imaging and functional testing (Optical Coherence Tomography (OCT), Autofluorescence (AF) and Humphrey 10-2 visual fields).ConclusionHCQ is widely used to treat autoimmune conditions with a proven survival benefit in patients with SLE. However, long-term use can be associated with irreversible retinal toxicity. These cases highlight that HCQ, like chloroquine, can also cause visual loss in susceptible individuals. Early detection of presymptomatic retinal changes by the introduction of appropriate screening and monitoring is mandatory to limit the extent of irreversible visual loss due to HCQ retinal toxicity.
目的
本病例系列的目的是提高对长期使用羟氯喹（HCQ）导致严重视网膜损伤这一新兴问题的认识，以及在治疗期间对视觉功能进行充分且适当监测的重要性。
患者与方法
这是一个小型回顾性病例系列，包含3例长期使用HCQ的患者，他们经影像学和功能测试确诊出现严重的症状性视网膜毒性。
结果
所有3例患者使用HCQ均超过15年；2例用于治疗类风湿关节炎（RA），第3例用于治疗系统性红斑狼疮（SLE）。所有3例患者均有不同程度的黄斑受累，经影像学和功能测试（光学相干断层扫描（OCT）、自发荧光（AF）和 Humphrey 10 - 2视野）的特征性表现得以证实。
结论
HCQ被广泛用于治疗自身免疫性疾病，已证实对SLE患者有生存益处。然而，长期使用可能会导致不可逆的视网膜毒性。这些病例表明，HCQ与氯喹一样，也会使易感个体出现视力丧失。通过引入适当的筛查和监测来早期发现症状前视网膜变化，对于限制因HCQ视网膜毒性导致的不可逆视力丧失程度至关重要。
