羟氯喹视网膜病变进展与停药阶段的关系。

IF 4.2 1区医学 Q1 OPHTHALMOLOGY

American Journal of Ophthalmology Pub Date : 2025-05-28 DOI:10.1016/j.ajo.2025.05.030

David J. Browning , Donnie R. Koonce , Akshay Mentreddy , Omar Punjabi

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引用次数: 0

摘要

目的：探讨羟氯喹视网膜病变（HCR）自停药至最后一次随访的进展情况。设计：回顾性、连续病例系列研究对象：17例羟氯喹视网膜病变患者，停用羟氯喹并维持随访。方法：回顾图表、视野和视网膜图像。四项辅助研究进行了调查：10-2视野（10-2 VF）、多焦视网膜电图（mfERG）、光谱域光学相干断层扫描（SD- OCT）和眼底自体荧光（FAF）成像。视网膜病变分为无视网膜病变、早期视网膜病变和晚期视网膜病变。主要观察指标：采用四种检测方法观察视网膜病变进展情况。结果：在17例患者中，至少进行了两次随访研究，以比较10-2 VF、mfERG、SD- OCT和FAF的进展情况，分别为17例、8例、16例和9例。10-2 VF、mfERG、SD- OCT和FAF的中位随访时间分别为25、22、41和37个月。10-2 VF、mfERG、SD-OCT、FAF停药时无视网膜病变进展眼的比例分别为0/0、3/5、0/0、2/6。10-2 VF、mfERG、SD-OCT、FAF发生早期视网膜病变的比例分别为4/6、0/6、2/15、3/7。10-2 VF、mfERG、SD-OCT、FAF进展为晚期视网膜病变的比例分别为16/20、0/5、10/17、5/5。在停药时没有视网膜色素上皮（RPE）丢失的病例中，可以看到视网膜病变的进展。并不是所有的辅助研究在诊断HCR时都显示视网膜病变。多焦点ERG显示地板效应。一旦反应密度低，通过这种方式检测毒性的进一步进展是不可能的。10-2 VF、SD-OCT和FAF的视网膜病变进展范围更广。结论：SD-OCT检测到中央凹旁椭球区反射率降低后停用羟氯喹，视网膜病变进展的概率较低。尽管停止药物，视网膜病变仍有可能进展的切点需要更早地移动到椭球带的不连续处。

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The Relationship of Hydroxychloroquine Retinopathy Progression to Stage at Cessation of Therapy

Purpose

To examine the progression of hydroxychloroquine retinopathy (HCR) from the time of drug cessation to the last follow-up.

Design

Retrospective, consecutive case series

Subjects

17 patients with HCR in whom drug was stopped and follow-up maintained.

Methods

Charts, visual fields, and retinal images were reviewed. Four ancillary studies were investigated: 10-2 visual fields (10-2 VF), multifocal electroretinography (mfERG), spectral domain optical coherence tomography (SD-OCT), and fundus autofluorescence (FAF) imaging. Retinopathy was graded as none, early, and advanced.

Main Outcome Measures

Progression of retinopathy by the four test methods.

Results

Of the 17 patients, the numbers with at least two follow-up studies to allow comparison for progression were 17, 8, 16, and 9 for 10-2 VF, mfERG, SD-OCT, and FAF, respectively. Median follow-ups were 25, 22, 41, and 37 months for 10-2 VF, mfERG, SD-OCT, and FAF, respectively. The proportions of eyes with no retinopathy at drug cessation that progressed were 0/0, 3/5, 0/0, and 2/6 for 10-2 VF, mfERG, SD-OCT, and FAF, respectively. The proportions of eyes with early retinopathy that progressed were 4/6, 0/6, 2/15, and 3/7 for 10-2 VF, mfERG, SD-OCT, and FAF, respectively. The proportions of eyes with advanced retinopathy that progressed were 16/20, 0/5, 10/17, and 5/5 for 10-2 VF, mfERG, SD-OCT, and FAF, respectively. Progression of retinopathy was seen in cases without retinal pigment epithelium loss at the time of drug cessation. Not all ancillary studies show retinopathy at the time of diagnosis of HCR. Multifocal ERG shows a floor effect. Once response densities are low, detecting further progression of toxicity by this modality is not possible. A greater breadth of retinopathy progression is possible with 10-2 VF, SD-OCT, and FAF.

Conclusions

If HC is stopped when decreased reflectivity of the parafoveal ellipsoid zone is detected by SD-OCT, the probability of retinopathy progression is low. The cut point at which progression of retinopathy is acknowledged to be likely despite drug cessation needs to be moved earlier to discontinuity of the ellipsoid zone.

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来源期刊

American Journal of Ophthalmology 医学-眼科学

CiteScore

9.20

自引率

7.10%

发文量

406

审稿时长

36 days

期刊介绍： The American Journal of Ophthalmology is a peer-reviewed, scientific publication that welcomes the submission of original, previously unpublished manuscripts directed to ophthalmologists and visual science specialists describing clinical investigations, clinical observations, and clinically relevant laboratory investigations. Published monthly since 1884, the full text of the American Journal of Ophthalmology and supplementary material are also presented online at www.AJO.com and on ScienceDirect. The American Journal of Ophthalmology publishes Full-Length Articles, Perspectives, Editorials, Correspondences, Books Reports and Announcements. Brief Reports and Case Reports are no longer published. We recommend submitting Brief Reports and Case Reports to our companion publication, the American Journal of Ophthalmology Case Reports. Manuscripts are accepted with the understanding that they have not been and will not be published elsewhere substantially in any format, and that there are no ethical problems with the content or data collection. Authors may be requested to produce the data upon which the manuscript is based and to answer expeditiously any questions about the manuscript or its authors.