Unit on Clinical Investigation of Retinal Disease, National Eye Institute, NIH, Bethesda, MD, USA.
Division of Epidemiology and Clinical Applications, National Eye Institute, Bethesda, Maryland, USA.
Br J Ophthalmol. 2023 Jun;107(6):849-855. doi: 10.1136/bjophthalmol-2021-319197. Epub 2022 Mar 14.
To determine the diagnostic validity of quantitative measures derived from optical coherence tomography (OCT) images in their ability to discriminate between cohorts of eyes unaffected by hydroxychloroquine (HCQ) and those with a range of toxicity severities, including mild toxicity.
Prospective, single-centre, case-control study conducted between August 2010 and May 2017. Participants were exposed to HCQ for at least 5 years (mean±SD =14±7.2 years) and classified into affected and unaffected cohorts based on the American Academy of Ophthalmology's 2016 recommendations. For affected eyes, severity (groups 1-4) was assigned based on the extent of ellipsoid zone loss. For all eyes, spectral domain-OCT scans were analysed quantitatively to compute inner retinal thickness (IRT), outer retinal thickness (ORT), and minimum signal intensity (MI) and compared across toxicity groups.
Of the 85 participants (mean age 59±12 years, 93% female), 30 had retinal toxicity. Significant differences in ORT and MI were observed between each affected severity group and unaffected eyes. Significant differences in IRT were observed for groups 3-4 but not groups 1-2. ORT and MI were each able to discriminate between unaffected and group 1 eyes with the highest discrimination at the inner subfields (areas under the curve, AUC=0.96 for ORT and AUC=0.93 for MI).
Quantitative analysis of OCT scans revealed significant differences between eyes with and without toxicity in two different measures. Each individual metric could discriminate between the unaffected and the lowest severity category, suggesting their potential utility in screening for HCQ toxicity in patients at risk.
确定从光学相干断层扫描（OCT）图像中得出的定量指标在区分未受羟氯喹（HCQ）影响的眼队列和具有不同毒性严重程度的眼队列（包括轻度毒性）方面的诊断有效性。
这是一项 2010 年 8 月至 2017 年 5 月期间进行的前瞻性、单中心、病例对照研究。参与者至少暴露于 HCQ 5 年（平均±SD=14±7.2 年），并根据美国眼科学会 2016 年的建议分为受影响和未受影响的队列。对于受影响的眼睛，根据椭圆体带丢失的程度来分配严重程度（组 1-4）。对所有眼睛进行光谱域-OCT 扫描进行定量分析，计算内视网膜厚度（IRT）、外视网膜厚度（ORT）和最小信号强度（MI），并在毒性组之间进行比较。
在 85 名参与者中（平均年龄 59±12 岁，93%为女性），有 30 名患有视网膜毒性。在每个受影响的严重程度组与未受影响的眼睛之间观察到 ORT 和 MI 存在显著差异。在组 3-4 中观察到 IRT 存在显著差异，但在组 1-2 中没有。ORT 和 MI 均能够区分未受影响和组 1 眼睛，在内子域的区分能力最高（ORT 的曲线下面积 AUC=0.96，MI 的 AUC=0.93）。
OCT 扫描的定量分析显示，在两种不同的测量方法中，受毒性影响和不受毒性影响的眼睛之间存在显著差异。每个单独的指标都可以区分未受影响和最低严重程度类别，这表明它们在筛查有 HCQ 毒性风险的患者方面具有潜在的效用。
