[羟氯喹视网膜病变筛查建议的更新]
[Update on recommendations for screening for hydroxychloroquine retinopathy].
作者信息
Couturier A, Giocanti-Aurégan A, Dupas B, Girmens J-F, Le Mer Y, Massamba N, Barreau E, Audo I
机构信息
Service d'ophtalmologie, hôpital Lariboisière, DHU vision et handicaps, université Paris 7-sorbonne Paris cité, AP-HP, 2, rue Ambroise-Paré, 75010 Paris, France.
Service d'ophtalmologie, DHU vision et handicaps, hôpital Avicenne, université Paris 13, AP-HP, 93000 Bobigny, France.
出版信息
J Fr Ophtalmol. 2017 Nov;40(9):793-800. doi: 10.1016/j.jfo.2017.08.002. Epub 2017 Oct 18.
INTRODUCTION
Recommendations for screening for chloroquine (CQ) and hydroxychloroquine (HCQ) retinopathy have recently been changed by the American Academy of Ophthalmology, taking into account new published data on toxicity prevalence, risk factors, location of onset in the retina and the efficacy of screening tests.
METHODS
Literature review.
RESULTS AND DISCUSSION
The risk of developing CQ or HCQ retinopathy depends on the daily dose and duration of treatment. At recommended doses, the risk is<1 % at 5 years, <2 % at 10years but increases to about 20 % after 20years of treatment. The maximum recommended daily dose is 5.0mg/kg for HCQ and 2.3mg/kg for CQ. The two main risk factors are the daily dose and duration of treatment. The presence of kidney failure and treatment with tamoxifen are also significant risk factors. A baseline examination should be performed at the initiation of treatment to rule out pre-existing maculopathy. The screening is then annual and starts from the 5th year of treatment. The two tests recommended for screening are the automated visual field and spectral domain OCT. Multifocal ERG and autofluorescence fundus imaging are only carried out secondarily to confirm the pathology.
引言
考虑到新发表的关于毒性患病率、危险因素、视网膜发病部位及筛查试验有效性的数据，美国眼科学会最近对氯喹（CQ）和羟氯喹（HCQ）视网膜病变的筛查建议进行了修订。
方法
文献综述。
结果与讨论
发生CQ或HCQ视网膜病变的风险取决于每日剂量和治疗持续时间。在推荐剂量下，5年时风险<1%，10年时<2%，但治疗20年后风险增至约20%。HCQ的最大推荐每日剂量为5.0mg/kg，CQ为2.3mg/kg。两个主要危险因素是每日剂量和治疗持续时间。肾衰竭的存在及他莫昔芬治疗也是重要的危险因素。治疗开始时应进行基线检查以排除既往存在的黄斑病变。然后从治疗第5年开始每年进行筛查。推荐用于筛查的两项检查是自动视野检查和光谱域光学相干断层扫描（OCT）。多焦视网膜电图和自发荧光眼底成像仅在次要情况下用于确诊病变。
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