Department of Ophthalmology, Hanyang University Hospital, Hanyang University College of Medicine, Seoul, Korea.
Retina. 2019 May;39(5):1016-1026. doi: 10.1097/IAE.0000000000002047.
To investigate the choroidal changes that occur in hydroxychloroquine (HCQ) retinopathy using multimodal imaging including fluorescein angiography, indocyanine green angiography, and optical coherence tomography (OCT) angiography and to correlate these changes with retinal findings obtained using OCT and fundus autofluorescence.
In 20 patients (n = 40 eyes) with systemic lupus erythematosus or rheumatoid arthritis diagnosed to have HCQ retinopathy, imaging modalities including swept-source OCT, fundus autofluorescence, fluorescein angiography, indocyanine green angiography, and OCT angiography were used to evaluate retinal and choroidal changes associated with retinopathy. The assessments included specific findings such as presence of hyperfluorescent or hypofluorescent lesions on angiography and signal void zones on OCT angiography, their frequencies, and the correlations among the retinal and choroidal findings. These findings were also correlated with the severity of retinopathy. Retinopathy progression was defined using fundus autofluorescence and OCT and correlated with the retinal/choroidal findings.
Fluorescein angiography demonstrated a hyperfluorescent area, which reflects a defective retinal pigment epithelium, with multiple tiny dark spots within the area. Indocyanine green angiography showed a hypofluorescent area with dark spots, which was matched to the hypoautofluorescent area on fundus autofluorescence. Although there were no specific morphologic abnormalities in the choroid layers using en face choroidal imaging, OCT angiography demonstrated signal void areas on the choriocapillaris in the areas of the retinal pigment epithelium defect. Even after cessation of HCQ, there was progression of retinopathy in eyes with choroidal involvement, particularly on the area of choroidal findings.
Multimodal imaging demonstrates choriocapillaris degeneration in eyes with HCQ retinopathy, particularly those with severe retinopathy. The choroidal change was associated with outer retinal toxicity of HCQ.
利用多模态成像（包括荧光素血管造影、吲哚菁绿血管造影和光相干断层扫描血管造影）研究羟氯喹（HCQ）性视网膜病变中发生的脉络膜变化，并将这些变化与使用光相干断层扫描和眼底自发荧光获得的视网膜发现相关联。
在 20 名（n = 40 只眼）系统性红斑狼疮或类风湿关节炎患者中，诊断为 HCQ 性视网膜病变，使用包括扫频源光相干断层扫描、眼底自发荧光、荧光素血管造影、吲哚菁绿血管造影和光相干断层扫描血管造影在内的成像方式来评估与视网膜病变相关的视网膜和脉络膜变化。评估包括血管造影上存在高荧光或低荧光病变以及光相干断层扫描血管造影上的信号缺失区等特定发现、其频率，以及视网膜和脉络膜发现之间的相关性。这些发现还与视网膜病变的严重程度相关。使用眼底自发荧光和光相干断层扫描来定义视网膜病变的进展，并与视网膜/脉络膜发现相关联。
荧光素血管造影显示出一个高荧光区域，反映了视网膜色素上皮的缺陷，该区域内有多个微小的暗点。吲哚菁绿血管造影显示出一个低荧光区域，伴有暗点，该区域与眼底自发荧光的低自发荧光区域相匹配。尽管使用面状脉络膜成像没有发现脉络膜层的特定形态异常，但光相干断层扫描血管造影显示在视网膜色素上皮缺陷区域的脉络膜毛细血管层存在信号缺失区。即使在停止使用 HCQ 后，有脉络膜受累的眼睛的视网膜病变仍会进展，特别是在脉络膜发现的区域。
多模态成像显示在 HCQ 性视网膜病变的眼中存在脉络膜毛细血管层变性，特别是在严重的视网膜病变眼中。脉络膜变化与 HCQ 的外视网膜毒性有关。
