Mavrikakis M, Papazoglou S, Sfikakis P P, Vaiopoulos G, Rougas K
Department of Clinical Therapeutics, 'Alexandra' Hospital, Athens, Greece.
Ann Rheum Dis. 1996 Mar;55(3):187-9. doi: 10.1136/ard.55.3.187.
To report clinical experience from patients with rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE) who were receiving recommended doses of hydroxychloroquine for more than six years, and were monitored for evidence of hydroxychloroquine related retinopathy every six months.
A prospective (and continuing) evaluation was made of the potential retinal toxicity of hydroxychloroquine in a cohort of 360 Greek patients followed for RA and SLE, 58 of whom have received long term treatment ( > six years). Fundoscopy, colour vision tests, dark adaptation tests, visual field testing, automated perimetry, and electroretinogram were performed every six months.
Among 58 patients receiving hydroxychloroquine for more than six years, two relatively young women (3.5%), one treated for RA and the other treated for SLE, developed characteristic hydroxychloroquine related toxic retinal lesions after cumulative doses of 700 g (6.5 years) and 730 g (8 years) of hydroxychloroquine, respectively. Bilateral visual acuity was 6/6 and 6/7.5, respectively; both patients had normal colour perception. Despite an early diagnosis and cessation of treatment, permanent visual field paracentral scotomata in both patients, and persisting lesions in fluorescein angiography in the patient with SLE, were observed at 4.5 and 3 years of follow up, respectively. No other specific cases of hydroxychloroquine related retinopathy have to date been identified in the remaining 302 patients.
Cases of irreversible, hydroxychloroquine related retinopathy in patients who did not receive overdoses have not been reported previously. The present observations in two relatively young patients should raise our concern regarding the long term usage of an increasingly popular medication in rheumatology practice.
报告类风湿关节炎（RA）和系统性红斑狼疮（SLE）患者接受推荐剂量羟氯喹超过六年，并每六个月监测羟氯喹相关性视网膜病变证据的临床经验。
对360例希腊RA和SLE患者队列进行前瞻性（且持续）评估，以观察羟氯喹的潜在视网膜毒性，其中58例接受了长期治疗（>六年）。每六个月进行一次眼底检查、色觉测试、暗适应测试、视野测试、自动视野计检查和视网膜电图检查。
在58例接受羟氯喹治疗超过六年的患者中，两名相对年轻的女性（3.5%），一名患有RA，另一名患有SLE，分别在累积服用700克（6.5年）和730克（8年）羟氯喹后出现了特征性的羟氯喹相关性毒性视网膜病变。双侧视力分别为6/6和6/7.5；两名患者色觉均正常。尽管早期诊断并停止治疗，但在随访4.5年和3年时，分别观察到两名患者出现永久性视野旁中心暗点，以及SLE患者荧光素血管造影中持续存在的病变。在其余302例患者中，迄今为止尚未发现其他羟氯喹相关性视网膜病变的具体病例。
此前尚未报道过未过量服用的患者出现不可逆的羟氯喹相关性视网膜病变的病例。目前在两名相对年轻患者中的观察结果应引起我们对这种在风湿病学实践中越来越常用药物长期使用的关注。
