Levy G D, Munz S J, Paschal J, Cohen H B, Pince K J, Peterson T
Kaiser Permanente Medical Center, Bellflower, California, USA.
Arthritis Rheum. 1997 Aug;40(8):1482-6. doi: 10.1002/art.1780400817.
To define the true risk of hydroxychloroquine (HCQ) retinal toxicity by studying the largest single group yet evaluated.
Retrospective chart review of all patients in the Kaiser Permanente Medical Care Program, Southern California Region, who had HCQ prescriptions filled from 1991 through 1993 (1,556 patients in 11 medical centers). Of 1,207 charts of patients who took HCQ and had documented ophthalmologic examinations, initial screening identified 21 charts (1.7%) that indicated possible HCQ toxicity.
We identified 1 patient with definite toxicity (1 of 1,207; 0.08%) and 5 other patients with indeterminate but probable toxicity (5 of 1,207; 0.4%). The incidence of definite HCQ retinal toxicity in patients treated with HCQ at <6.5 mg/kg/day was 0.
In HCQ-treated patients whose renal function is normal, routine ophthalmic screening is not indicated if the daily dosage is <6.5 mg/kg. In patients whose daily dosage is >6.5 mg/kg or who have taken HCQ continuously for > 10 years, annual screening may be appropriate.
通过研究迄今为止评估的最大单一群体来确定羟氯喹（HCQ）视网膜毒性的真实风险。
对南加州地区凯撒医疗保健计划中1991年至1993年期间开具HCQ处方的所有患者（11个医疗中心的1556名患者）进行回顾性病历审查。在1207名服用HCQ且有眼科检查记录的患者病历中，初步筛查发现21份病历（1.7%）显示可能存在HCQ毒性。
我们确定1例明确毒性患者（1207例中的1例；0.08%）和另外5例毒性不确定但可能存在毒性的患者（1207例中的5例；0.4%）。每日剂量<6.5mg/kg接受HCQ治疗的患者中明确的HCQ视网膜毒性发生率为0。
在肾功能正常且接受HCQ治疗的患者中，如果每日剂量<6.5mg/kg，则无需进行常规眼科筛查。对于每日剂量>6.5mg/kg或连续服用HCQ超过10年的患者，每年进行筛查可能是合适的。
