Sebastiani Stefano, Fresina Michela, Cellini Mauro, Campos Emilio C
Department of Experimental, Diagnostic, and Specialty Medicine, Ophthalmology Service, University of Bologna, Bologna, Italy.
Clin Ophthalmol. 2017 Apr 11;11:689-696. doi: 10.2147/OPTH.S130899. eCollection 2017.
To evaluate early changes in multifocal electroretinogram (mfERG) and subclinical aqueous humor flare and cellularity in patients receiving hydroxychloroquine (HCQ) as treatment for rheumatoid arthritis.
Ten patients receiving treatment with HCQ and no ophthalmic symptoms were enrolled. After complete ocular examination, mfERG and laser flare-cell photometry were performed. Patients were also divided into two subgroups with HCQ cumulative dose (CD) higher or lower than 500 g. Results obtained were compared with a control group of ten healthy subjects and statistical analysis was performed.
In patients receiving HCQ treatment, mfERG P1-wave in ring 2 showed a significant reduction in amplitude and a significant increase in latency compared to healthy control subjects, respectively resulting in 1.143 μV vs 1.316 μV (=0.040) and 38.611 ms vs 36.334 ms (=0.024). These changes are highly related to CD. Furthermore, when using the laser flare-cell photometry, a significant increase in aqueous humor flare and cellularity was shown in patients with CD higher than 500 g, resulting in a mean value of 14.4 ph/ms compared to 8.1 ph/ms in patients with CD lower than 500 g (=0.0029). These reports appear highly related to CD (=0.001). Receiver operating characteristic curve analysis showed mfERG P1-wave amplitude in ring 2 as the most sensitive value in detecting early HCQ-related retinopathy.
MfERG was shown to be a very sensitive test in detecting early retinal toxicity and should be used for the screening of patients receiving HCQ treatment. Although less sensitive, laser flare-cell photometry can provide further information to evaluate early toxic retinal cell damage.
评估接受羟氯喹（HCQ）治疗类风湿关节炎患者的多焦视网膜电图（mfERG）以及亚临床房水闪光和细胞数的早期变化。
纳入10例接受HCQ治疗且无眼部症状的患者。在完成全面眼部检查后，进行mfERG和激光闪光细胞光度测定。患者还根据HCQ累积剂量（CD）高于或低于500克分为两个亚组。将所得结果与10名健康受试者的对照组进行比较，并进行统计分析。
在接受HCQ治疗的患者中，与健康对照受试者相比，环2中的mfERG P1波振幅显著降低，潜伏期显著增加，分别为1.143 μV对1.316 μV（P = 0.040）和38.611 ms对36.334 ms（P = 0.024）。这些变化与累积剂量高度相关。此外，使用激光闪光细胞光度测定时，累积剂量高于500克的患者房水闪光和细胞数显著增加，平均值为14.4 ph/ms，而累积剂量低于500克的患者为8.1 ph/ms（P = 0.0029）。这些结果似乎与累积剂量高度相关（P = 0.001）。受试者工作特征曲线分析显示，环2中的mfERG P1波振幅是检测早期HCQ相关视网膜病变最敏感的值。
mfERG被证明是检测早期视网膜毒性的非常敏感的测试，应用于接受HCQ治疗患者的筛查。虽然激光闪光细胞光度测定不太敏感，但可提供进一步信息以评估早期毒性视网膜细胞损伤。
