Disparity between Visual Fields and Optical Coherence Tomography in Hydroxychloroquine Retinopathy
Disparity between Visual Fields and Optical Coherence Tomography in Hydroxychloroquine Retinopathy
复制标题
DOI：
10.1016/j.ophtha.2013.12.002
复制
发表时间：
2014-06-01
期刊：
影响因子：
13.7
通讯作者：
Melles, Ronald B.
中科院分区：
文献类型：
--
作者：
Marmor, Michael F.;Melles, Ronald B.
目的：美国眼科学会对羟氯喹（HCQ）视网膜病变筛查的建议建议采用客观的测量方法，如光谱域光学相干断层扫描（SD-OCT）和多焦视网膜电图（mfERG）以及视野沿着。然而，筛查试验的相对灵敏度和特异性尚未完全解决。我们描述了一个子集的患者毒性谁显示不寻常的差距之间的领域和SD-OCT，从而有影响筛选practice.Design：审查图表和临床data.Participants：患者在斯坦福大学和凯泽Permanente谁曾使用HCQ大于1000克累积曝光。2000多例患者中有150例有明显的毒性反应（10-2白色瑞典交互阈值算法模式偏差图），SD-OCT，有时mfERG或眼底自发荧光。主要结果测量：与SD-OCT相比视野的相对结果。结果：在HCQ中毒的患者中，有11名患者出现视周环暗点，但SD-OCT表现正常，没有黄斑疾病史或任何其他原因导致牛眼黄斑病变的证据。相反，所有的情况下，具有明确程度的旁皮层损伤的SD-OCT显示至少有一些焦点旁皮层field loss.Conclusions：约10%的早期HCQ毒性患者表现出突出的环形暗点上没有明显的SD-OCT异常的现场测试。这应该鼓励将视野作为关键筛查工具，即使还进行SD-OCT（更具体和客观的测试）也是如此。视野和SD-OCT的组合提供了灵敏度和特异性，同时避免了不必要的药物停止。(C)2014年由美国眼科学会。
Purpose: American Academy of Ophthalmology recommendations for screening for hydroxychloroquine (HCQ) retinopathy advise objective measures, such as spectral-domain optical coherence tomography (SD-OCT) and multifocal electroretinography (mfERG) along with visual fields. However, the relative sensitivity and specificity of screening tests have not been fully resolved. We characterize a subset of patients with toxicity who show unusual disparity between fields and SD-OCT and thus have implications for screening practice.Design: Review of charts and clinical data.Participants: Patients at Stanford and Kaiser Permanente who had used HCQ with greater than 1000 g cumulative exposure. There were more than 2000 such individuals, among whom 150 had clear evidence of toxicity.Methods: Patients were evaluated by visual fields (10-2 white Swedish Interactive Threshold Algorithm pattern deviation plots), SD-OCT, and sometimes mfERG or fundus autofluorescence.Main Outcome Measures: Relative findings on visual fields in comparison with SD-OCT.Results: There were 11 patients among those with HCQ toxicity who had parafoveal ring scotomas but a normal-appearing SD-OCT. None had a history of macular disease or evidence for any other cause of bull's eye maculopathy. Conversely, all cases with a clear degree of parafoveal damage on SD-OCT showed at least some focal spots of parafoveal field loss.Conclusions: Approximately 10% of patients with early HCQ toxicity showed prominent ring scotomas on field testing without obvious SD-OCT abnormality. This should encourage the inclusion of visual fields as a key screening tool, even when SD-OCT (a more specific and objective test) also is performed. The combination of visual fields and SD-OCT gives both sensitivity and specificity while avoiding unnecessary stoppage of the drug. (C) 2014 by the American Academy of Ophthalmology.