用于系统性红斑狼疮患者羟氯喹诱导视网膜毒性亚临床检测的多模态成像方法的新建议。
New proposal for a multimodal imaging approach for the subclinical detection of hydroxychloroquine-induced retinal toxicity in patients with systemic lupus erythematosus.
机构信息
Department of Autoimmune Diseases, Reference Centre for Systemic Autoimmune Diseases, Vasculitis and Autoinflammatory Diseases (UEC/CSUR) of the Catalan and Spanish Health Systems. Member of ERN-ReCONNET/RITA. Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Catalonia, Spain.
Department of Ophthalmology, Hospital Clinic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Catalonia, Spain.
出版信息
BMJ Open Ophthalmol. 2024 Mar 18;9(1):e001608. doi: 10.1136/bmjophth-2023-001608.
OBJECTIVE
To compare multimodal structural and functional diagnostic methods in patients with systemic lupus erythematosus (SLE) treated with hydroxychloroquine, to identify the best complementary approach for detecting subclinical retinal toxicity.
METHODS
A cross-sectional, unicentric study was conducted on patients with SLE treated with hydroxychloroquine. Each patient underwent a comprehensive ophthalmic evaluation, comprising structural tests (spectral-domain optical coherence tomography (SD-OCT), OCT, OCT angiography (OCTA), fundus autofluorescence (FAF)) and functional tests (automated perimetry for visual field (VF) testing, multifocal electroretinography (mfERG)). A diagnosis of macular toxicity required the presence of abnormalities in at least one structural and functional test. The Kappa Concordance Index was used to assess the concordance among the different tests in detecting potential macular toxicity-associated alterations.
RESULTS
Sixty-six patients with SLE (132 eyes) were consecutively enrolled. Four (6.1%) patients developed subclinical hydroxychloroquine-induced retinal toxicity without visual acuity impairment. The proportion of abnormal results was 24% for both OCT and OCTA. Regarding functional analysis, VF was less specific than mfERG in detecting subclinical retinal toxicity (VF specificity 47.5%). OCT and OCTA structural findings showed better concordance, with a index >0.8, and both identified the same cases of toxicity as FAF.
CONCLUSION
Although structural OCT and VF are frequently used to screen for hydroxychloroquine-induced retinal toxicity, our findings suggest that a combination of mfERG, OCT and OCTA could improve the diagnostic accuracy for subclinical retinal damage. This study emphasises the importance of a multimodal imaging strategy to promptly detect signs of hydroxychloroquine-induced retinal toxicity.
目的
比较接受羟氯喹治疗的系统性红斑狼疮（SLE）患者的多模态结构和功能诊断方法，以确定检测亚临床视网膜毒性的最佳互补方法。
方法
进行了一项横断面、单中心研究，纳入了接受羟氯喹治疗的 SLE 患者。每位患者均接受全面的眼科评估，包括结构测试（频域光相干断层扫描（SD-OCT）、OCT、OCT 血管造影（OCTA）、眼底自发荧光（FAF））和功能测试（自动视野计进行视野（VF）测试、多焦视网膜电图（mfERG））。只有在至少一项结构和功能测试中存在异常时，才诊断为黄斑毒性。Kappa 一致性指数用于评估不同测试在检测潜在黄斑毒性相关改变方面的一致性。
结果
连续纳入 66 例 SLE 患者（132 只眼）。4 例（6.1%）患者出现亚临床羟氯喹诱导的视网膜毒性而无视力损害。OCT 和 OCTA 的异常结果比例均为 24%。关于功能分析，VF 比 mfERG 特异性更低，在检测亚临床视网膜毒性方面（VF 特异性 47.5%）。结构分析中 OCT 和 OCTA 的发现一致性更好，κ 指数>0.8，并且两者均识别出与 FAF 相同的毒性病例。
结论
尽管结构 OCT 和 VF 常用于筛查羟氯喹诱导的视网膜毒性，但我们的研究结果表明，mfERG、OCT 和 OCTA 的联合应用可能会提高亚临床视网膜损伤的诊断准确性。本研究强调了多模态成像策略的重要性，以便及时发现羟氯喹诱导的视网膜毒性的迹象。
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