Clinical evaluation of the new screening procedures for hydroxychloroquine retinopathy, according to the American Academy of Ophthalmology guidelines. Prospective study of 184 patients
Clinical evaluation of the new screening procedures for hydroxychloroquine retinopathy, according to the American Academy of Ophthalmology guidelines. Prospective study of 184 patients
复制标题
DOI：
10.1016/j.jfo.2015.01.005
复制
发表时间：
2015-05-01
影响因子：
1.2
通讯作者：
Mortemousque, B.
中科院分区：
文献类型：
--
作者：
Jaumouille, S.;Espargilliere, D.;Mortemousque, B.
目的. - 根据美国眼科学会2011年的新建议，比较临床实践中羟氯喹视网膜病变筛查程序的结果。- 在一项前瞻性单中心研究中，对184例长期服用羟氯喹的患者进行了眼科评估，包括眼底检查、10.2自动视野、眼底自发荧光、SD-OCT光学相干断层扫描和多焦ERG。- HCQ累积剂量与SD-OCT和10.2视野的阳性结果之间存在显著相关性（P < 0.05）。高累积HCQ剂量与眼底检查、自体荧光或多焦ERG阳性结果之间无显著相关性。健康组平均累积剂量（946 g）与黄斑病变组平均累积剂量（1427 g）比较，差异有统计学意义（P < 0.05）。在184例患者中，发现12例中毒性黄斑病变（患病率6.5%）。在这12例病例中，5例在临床阶段被诊断，7例在早期临床前阶段被诊断。10例患者有阳性视野，8例患者有病理性SD-OCT体征。自体荧光在临床阶段受到影响，但在临床前阶段不受影响。在12例黄斑病变中，4例患者的ERG结果为病理性。- 累积HCQ剂量（被认为是黄斑病变的主要风险因素）与阳性SD-OCT和10.2视野结果之间的显著相关性使得这两种测试的组合成为Plaquenil黄斑病变筛选策略的基础。这些结果建议使用简化的筛选程序，包括每年SD-OCT和10.2视野，同时考虑累积剂量。多焦视网膜电图似乎更有助于诊断确认比筛选，特别是在临床前阶段。眼底自体荧光检查不是早期诊断的有效方法。(C)2015年Elsevier Masson SAS。All rights reserved.
Purpose. - To compare the results, in clinical practice, of screening procedures for hydoxychloroquine retinopathy, according to the new recommendations of the American Academy of Ophthalmology of 2011.Methods. - Hundred and eighty-four patients on long-term hydroxychloroquine underwent ophthalmologic evaluation, including fundus examination, 10.2 automated visual field, fundus autofluorescence, SD-OCT optical coherence tomography, and multifocal ERG, whenever possible, in a prospective monocentric study.Results. - There was a significant correlation (P < 0.05) between cumulative HCQ dose and positive results on SD-OCT and 10.2 visual field. There were no significant correlations between high cumulative HCQ dose and positive results for fundus examination, autofluorescence, or multifocal ERG. Average cumulative doses between the healthy group (946 g) and the maculopathy group (1427 g) were significantly different (P < 0.05). Out of 184 patients, 12 toxic maculopathies were found (prevalence 6.5%). For these 12 cases, 5 were diagnosed at clinical stages, and 7 were diagnosed in the early preclinical stage. Ten patients had positive visual fields, and 8 patients had pathological SD-OCT signs. Autofluorescence was affected in the clinical stage, but not in the preclinical stage. In four out of the twelve cases of maculopathy, patients had pathological ERG results.Conclusion. - The significant correlation between cumulative HCQ dose, considered as the main risk factor for maculopathy, and positive SD-OCT and 10.2 visual field results render the combination of these two tests the basis of the screening strategy for plaquenil maculopathy. These results suggest using a simplified screening procedure, including annual SD-OCT and 10.2 visual field while taking the cumulative dose into account. Multifocal ERG seems more helpful for diagnostic confirmation than screening, especially for the preclinical stage. Fundus autofluorescenceis not an efficient test for early diagnosis. (C) 2015 Elsevier Masson SAS. All rights reserved.