Department of Ophthalmology, Columbia University Medical Center, New York, New York, United States.
Department of Ophthalmology, New York University School of Medicine, New York, New York, United States.
Invest Ophthalmol Vis Sci. 2020 Sep 1;61(11):41. doi: 10.1167/iovs.61.11.41.
To increase our understanding of the mechanisms underlying hydroxychloroquine (HCQ) retinopathy, analyses by quantitative fundus autofluorescence (qAF) and near-infrared fundus autofluorescence (NIR-AF) were compared to results obtained by recommended screening tests.
Thirty-one patients (28 females, 3 males) were evaluated with standard automated perimetry and spectral domain optical coherence tomography (SD-OCT); 28 also had multifocal electroretinography (mfERG). Measurement of short-wavelength fundus autofluorescence (SW-AF) by qAF involved the use of an internal fluorescent reference and intensity measurements in eight concentric segments at 7° to 9° eccentricity. For semiquantitative analysis of NIR-AF, intensities were acquired along a vertical axis through the fovea.
Four of 15 high-dose (total dose >1000 g, daily dose >5.0 mg/kg) patients and one of 16 low-dose (total dose <1000 g, daily dose 4.4 mg/kg) patients were diagnosed with HCQ-associated retinopathy based on abnormal 10-2 visual fields, SD-OCT, and SW-AF imaging. Three of the high-dose patients also had abnormal mfERG results. Of the five patients exhibiting retinopathy, two had qAF color-coded images revealing higher intensities inferior, nasal, and lateral to the fovea. The abnormal visual fields also exhibited superior-inferior differences. Mean NIR-AF gray-level intensities were increased in four high-dose patients with no evidence of retinopathy. In two patients with retinopathy, NIR-AF intensity within the parafovea was below the normal range. One high-dose patient (6.25 mg/kg) had only abnormal mfERG results.
These findings indicate that screening for HCQ retinopathy should take into consideration superior-inferior differences in susceptibility to HCQ retinopathy.
为了深入了解羟氯喹（HCQ）视网膜病变的发病机制，我们对定量眼底自发荧光（qAF）和近红外眼底自发荧光（NIR-AF）分析的结果与推荐的筛查试验进行了比较。
对 31 名患者（28 名女性，3 名男性）进行了标准自动视野计和光谱域光学相干断层扫描（SD-OCT）检查；28 名患者还进行了多焦视网膜电图（mfERG）检查。采用 qAF 测量短波眼底自发荧光（SW-AF）时，需要使用内部荧光参考，并在 7°至 9°偏心处的 8 个同心段进行强度测量。为了对 NIR-AF 进行半定量分析，在通过黄斑的垂直轴上获取强度。
根据异常的 10-2 视野、SD-OCT 和 SW-AF 成像，15 名高剂量（总剂量>1000g，日剂量>5.0mg/kg）患者中有 4 名和 16 名低剂量（总剂量<1000g，日剂量 4.4mg/kg）患者中有 1 名被诊断为 HCQ 相关性视网膜病变。高剂量组的 3 名患者 mfERG 结果也异常。在 5 名出现视网膜病变的患者中，有 2 名 qAF 彩色编码图像显示黄斑下、鼻侧和外侧的荧光强度更高。异常的视野也表现出上下差异。在 4 名无视网膜病变的高剂量患者中，NIR-AF 灰度强度增加。在 2 名有视网膜病变的患者中，旁黄斑区的 NIR-AF 强度低于正常范围。一名高剂量患者（6.25mg/kg）只有异常 mfERG 结果。
这些发现表明，HCQ 视网膜病变的筛查应考虑到对 HCQ 视网膜病变易感性的上下差异。
