LOSS OF EXTERNAL LIMITING MEMBRANE INTEGRITY PREDICTS PROGRESSION OF HYDROXYCHLOROQUINE RETINAL TOXICITY AFTER DRUG DISCONTINUATION
LOSS OF EXTERNAL LIMITING MEMBRANE INTEGRITY PREDICTS PROGRESSION OF HYDROXYCHLOROQUINE RETINAL TOXICITY AFTER DRUG DISCONTINUATION
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DOI：
10.1097/iae.0000000000001217
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发表时间：
2016-10-01
影响因子：
3.3
通讯作者：
Fawzi, Amani A.
中科院分区：
文献类型：
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作者：
Scarinci, Fabio;Shaarawy, Amr;Fawzi, Amani A.
目的：为了量化随着时间的推移，外部界膜（ELM）的破坏和感光体体积，使用光谱域光学相干断层扫描仪在眼睛与羟氯喹（HCQ）的毒性作用后determination.Methods：我们进行了回顾性图表审查的患者谁是筛选HCQ的毒性作用之间的2009年1月1日和2014年8月31日，并确定了10例诊断为HCQ视网膜毒性作用。使用ImageJ软件手动追踪完整的ELM和Bruch膜，并将它们来自光谱域光学相干断层扫描黄斑体积的每次扫描的长度相加。计算完整ELM长度/Bruch膜长度的比率。我们在每个横截面B扫描中测量了完整的ELM和Bruch膜之间的二维光感受器面积。结果：10例患者（120只眼）中，1只眼因玻璃体黄斑牵引而被排除。HCQ的平均累积剂量为1，951 g（范围：584- 3，650 g）。平均随访时间为34.1个月（范围：11-64个月）。根据诊断HCQ毒性时ELM完整性的程度，我们将眼睛分为2组：1）12只眼睛显示严重的ELM破坏，2）7只眼睛具有完整的ELM。所有19只眼睛在基线时的视野检查中都显示出HCQ毒性的特征性体征。12只ELM破坏的眼睛中有7只表现出进行性ELM变化，包括7只眼睛另外出现进行性感光细胞体积下降，而5只眼睛保持稳定。完整的ELM的所有7只眼睛保持稳定，随着时间的推移。结论：完整的ELM状态在HCQ中止时是一个良好的预后标志，ELM状态可以让临床医生预测患者的视网膜病变进展的风险。定量测量ELM中断和光感受器体积可以提供客观的工具，以监测外部视网膜的变化，由于HCQ。
Purpose:To quantify external limiting membrane (ELM) disruption and photoreceptor volume over time, using spectral domain optical coherence tomography in eyes with hydroxychloroquine (HCQ) toxic effects after discontinuation.Methods:We performed a retrospective chart review of patients who were screened for toxic effects of HCQ between January 1, 2009 and August 31, 2014, and identified 10 patients diagnosed as having HCQ retinal toxic effects. Intact ELM and the Bruch membrane were manually traced using ImageJ software and their lengths from each scan of the spectral domain optical coherence tomography macular volume were summed. The ratio of intact ELM length/Bruch membrane length was calculated. We measured the two-dimensional photoreceptor area between the intact ELM and Bruch membrane in every cross-sectional B-scan. We calculated the total volume of photoreceptors in a volumetric OCT by multiplying photoreceptor area by the distance between B-scans.Results:Of the 10 patients (120 eyes), 1 eye was excluded because of the presence of vitreomacular traction. The mean cumulative dose of HCQ was 1,951 g (range, 584-3,650 g). The mean follow-up duration was 34.1 months (range, 11-64 months). Based on the extent of ELM integrity at diagnosis of HCQ toxicity, we classified eyes into 2 groups: 1) 12 eyes showed severe ELM disruption and 2) 7 eyes had intact ELM. All 19 eyes showed characteristic signs of HCQ toxicity on the visual field examination at the baseline. Seven of 12 eyes with ELM disruption showed progressive ELM changes, including 7 eyes that additionally developed progressive photoreceptor volume decline, whereas 5 eyes remained stable. All 7 eyes with intact ELM remained stable over time.Conclusion:Intact ELM status at the time of HCQ discontinuation is a good prognostic sign, and ELM status may allow clinicians to predict patients at risk for progression of retinopathy. Quantitative measurements of ELM disruption and photoreceptors volume may provide an objective tool to monitor outer retinal changes due to HCQ.