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通过视网膜外界膜完整性的损失情况预测停药后羟氯喹引起的视网膜毒性反应进展

Scarinci F, Shaarawy A, Narala R, et al.

期刊名称:Retina

卷期:2016年第36卷第10期

摘要

目的:本研究旨在采用谱域光学相干断层扫描技术量化发生羟氯喹(HCQ)毒性反应的眼睛在停药后其视网膜外界膜(ELM)随时间的破坏情况和感光细胞体积。研究方法:筛选在2009年1月1日和2014年8月31日之间发生HCQ毒性反应的患者,我们对这些患者进行回顾性病历审查,确定出10名被诊断为视网膜毒性反应的患者。我们采用ImageJ软件手动追踪完整的ELM和布鲁赫膜,并记录每次采用谱域光学相干断层扫描黄斑体积时这两种膜的长度。计算完整ELM长度/布鲁赫膜长度的比率。我们测量了每个横截面B-扫描中的完整ELM和布鲁赫膜之间的二维感光细胞面积。我们还计算了OCT检测的感光细胞总体积,通过感光细胞面积乘以B-扫描之间的距离得到。研究结果:在10名患者中(120只眼),1只眼因存在玻璃体黄斑牵引而被排除在外。HCQ的平均累积剂量为1951 g(范围,584-3650 g)。平均随访时间为34.1个月(范围,11-64个月)。根据HCQ毒性诊断中的ELM完整性程度,我们将患者眼分为2组:1)12只眼表现为ELM严重破裂,2)7只眼具有完整ELM。全部19只眼在基线处的视野检查中表现为HCQ毒性反应的特征性症状。12只眼中7只ELM发生破裂的眼显示患者产生进行性的ELM变化,还包括该7只眼发生渐进性感光细胞体积下降,而另外5只眼则保持状态稳定。具完整ELM的7只眼在一段时间内保持稳定。研究结论:HCQ停药时ELM保持完整状态是预后良好的标志,并且ELM状态可以使医生预测发生视网膜病变进展的高危患者。对ELM破坏情况和感光细胞体积的定量测量可以为监测由HCQ导致的外层视网膜变化提供一种客观手段。

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.


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