Using multifocal ERG ring ratios to detect and follow Plaquenil retinal toxicity: a review
Using multifocal ERG ring ratios to detect and follow Plaquenil retinal toxicity: a review
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DOI：
10.1007/s10633-008-9130-0
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发表时间：
2009-02-01
影响因子：
1.4
通讯作者：
Severns, Matthew L.
中科院分区：
文献类型：
--
作者：
Lyons, Jonathan S.;Severns, Matthew L.
多焦点ERG环比值为检测羟基氯喹（Plaquenil）患者的眼毒性提供了一种敏感、客观的方法。为了测量环比，计算了61-六边形mfERG的五个同心环的平均mfERG振幅。然后计算中央六边形（R-1）的年龄校正振幅以及R-1与每个相邻环（R-1/R-2， R-1/R-3等）的比值。从67个正常对照人群中建立环比率的标准值。在研究人群中，如果一个环高于正常人群99%的置信限，就被认为是异常的。这项技术在62名服用Plaquenil的患者的131只眼睛上进行了评估，这些患者患有各种疾病，包括类风湿关节炎、系统性红斑狼疮和干燥综合征。长期服用Plaquenil的患者，无论他们服用该药的情况如何，其视网膜毒性的发生率都较高。在累计剂量小于1250 g的患者中，67只眼中有7只（10%）出现特征性mfERG缺陷，而在累计剂量大于1250 g的患者中，64只眼中有26只（41%）出现上述缺陷之一。在至少一名患者中，该技术能够检测到Plaquenil毒性的早期发作，并在停药后毒性作用逆转。建议对所有接受吡喹尼治疗的患者进行mfERG检测似乎是合适的。
Multifocal ERG ring ratios provide a sensitive and objective method to detect ocular toxicity in patients taking hydroxychloroquine (Plaquenil). In order to measure ring ratios, the average mfERG amplitude was calculated for each of five concentric rings of a 61-hexagon mfERG. The age-corrected amplitude of the central hexagon (R-1) and the ratios of R-1 to each of the successive rings (R-1/R-2, R-1/R-3, etc.) were then computed. Normative values for ring ratios were established from a population of 67 normal controls. In the study population, a ring was considered abnormal if it was above the 99% confidence limits for the normal population. The technique was evaluated on 131 eyes of 62 patients taking Plaquenil for a variety of conditions including rheumatoid arthritis, systemic lupus erythematosus, and Sjogren's syndrome. Patients who had taken Plaquenil for an extended period showed a higher incidence of retinal toxicity, regardless of the condition for which they were taking the drug. Among patients who had taken a cumulative dose of less than 1,250 g, 7 of 67 eyes (10%) showed a characteristic mfERG defect, while in patients with a cumulative dosage of 1,250 g or more, 26 of 64 eyes (41%) showed one of these defects. In at least one patient, the technique was able to detect the early onset of Plaquenil toxicity followed by reversal of the toxic effects after the medication was discontinued. It appears appropriate to recommend that mfERG testing be done on all patients on Plaquenil therapy.