Kim Ko Eun, Kim Young Hwan, Kim Jiyeong, Ahn Seong Joon
From Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea (K.E.K).
Department of Ophthalmology, Hanyang University Hospital, Hanyang University College of Medicine, Seoul, Republic of Korea (Y.H.K, S.J.A).
Am J Ophthalmol. 2023 Jan;245:70-80. doi: 10.1016/j.ajo.2022.07.028. Epub 2022 Aug 11.
To investigate macular ganglion cell complex (GCC) and peripapillary retinal nerve fiber layer (RNFL) thicknesses in patients with hydroxychloroquine retinopathy of differing severity.
Cross-sectional, case-control comparison study.
From patients screened for hydroxychloroquine retinopathy between January 2016 and October 2021 using swept-source optical coherence tomography (SS-OCT), fundus autofluorescence (FAF), and standard automated perimetry, 66 patients with retinopathy and 66 without retinopathy were included by 1:1 propensity score matching based on age, sex, systemic diseases, history of tamoxifen and pentosan use, and kidney disease.
Eyes with hydroxychloroquine retinopathy were divided into early, moderate, and severe stages. Inner-retinal thickness parameters, including macular GCC (RNFL + ganglion cell layer + inner plexiform layer) and peripapillary RNFL thicknesses, were automatically obtained using SS-OCT (DRI-OCT Triton, Topcon Inc., Japan) and compared between patients with and without retinopathy and between severity subgroups. The structure-function relationships between GCC or peripapillary RNFL thicknesses and perimetric parameters including mean deviation (MD) and visual field index (VFI) of Humphrey 30-2 test were evaluated.
Macular GCC and peripapillary RNFL thickness parameters.
The average macular GCC and peripapillary RNFL thicknesses were significantly decreased in patients with hydroxychloroquine retinopathy relative to those without retinopathy. Macular GCC thicknesses in 4 of 6 macular sectors and peripapillary RNFL thicknesses in 9 of 12 clock-hour sectors were significantly different between the groups. The differences in the average and sectoral macular GCC parameters were statistically significant among the severity subgroups, particularly between severe and earlier stages. Average macular GCC and peripapillary RNFL thicknesses significantly correlated with MD and VFI in all patients (all P < .001).
Macular GCC and peripapillary RNFL thinning was more prominent in eyes with severe hydroxychloroquine retinopathy, as indicative of inner-retinal thinning in eyes with advanced-stage disease. Further, as inner-retinal thinning showed a significant correlation with worse perimetric function, cautious evaluation of the inner retina may be required for eyes with advanced hydroxychloroquine retinopathy.
研究不同严重程度的羟氯喹视网膜病变患者的黄斑神经节细胞复合体（GCC）和视乳头周围视网膜神经纤维层（RNFL）厚度。
横断面病例对照比较研究。
在2016年1月至2021年10月期间，使用扫频光学相干断层扫描（SS-OCT）、眼底自发荧光（FAF）和标准自动视野计对羟氯喹视网膜病变进行筛查的患者中，根据年龄、性别、全身疾病、他莫昔芬和戊聚糖使用史以及肾病，通过1:1倾向评分匹配纳入66例患有视网膜病变的患者和66例无视网膜病变的患者。
将患有羟氯喹视网膜病变的眼睛分为早期、中度和重度阶段。使用SS-OCT（DRI-OCT Triton，日本拓普康公司）自动获取视网膜内层厚度参数，包括黄斑GCC（RNFL + 神经节细胞层 + 内网状层）和视乳头周围RNFL厚度，并在有和无视网膜病变的患者之间以及严重程度亚组之间进行比较。评估GCC或视乳头周围RNFL厚度与Humphrey 30-2测试的平均偏差（MD）和视野指数（VFI）等视野参数之间的结构-功能关系。
黄斑GCC和视乳头周围RNFL厚度参数。
与无视网膜病变的患者相比，患有羟氯喹视网膜病变的患者黄斑GCC和视乳头周围RNFL的平均厚度显著降低。两组之间6个黄斑区中的4个黄斑区的GCC厚度和12个钟点区中的9个钟点区的视乳头周围RNFL厚度存在显著差异。严重程度亚组之间，尤其是重度和早期阶段之间，黄斑GCC平均参数和扇形参数的差异具有统计学意义。在所有患者中，黄斑GCC和视乳头周围RNFL的平均厚度与MD和VFI均显著相关（所有P < .001）。
在患有严重羟氯喹视网膜病变的眼中，黄斑GCC和视乳头周围RNFL变薄更为明显，这表明晚期疾病眼中视网膜内层变薄。此外，由于视网膜内层变薄与较差的视野功能显著相关，对于患有晚期羟氯喹视网膜病变的眼睛，可能需要谨慎评估视网膜内层情况。
