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Abstract：
OBJECTIVE: 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 (946g) and the maculopathy group (1427g) 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.
CONCLUSIONS: 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 autofluorescence is not an efficient test for early diagnosis.
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 (946g) and the maculopathy group (1427g) 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.
CONCLUSIONS: 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 autofluorescence is not an efficient test for early diagnosis.
摘要：
目的：为了比较结果，在临床实践中，羟氯喹视网膜病变的筛查程序，根据美国眼科学会2011年的新建议。
方法：104名长期服用羟氯喹的患者接受了眼科评估，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,和多病灶ERG，只要有可能,在一项前瞻性单中心研究中。
结果：HCQ累积剂量与SD-OCT和10.2视野阳性结果之间存在显著相关性（P<0.05）。高累积HCQ剂量与眼底检查阳性结果之间没有显着相关性，自发荧光,或多病灶ERG。健康组(946g)和黄斑病变组(1427g)的平均累积剂量差异有统计学意义(P<0.05)。184名患者中,发现12例毒性黄斑病变(患病率6.5%)。对于这12个案例，5在临床阶段被诊断出，7例诊断为临床前早期。10例患者视野呈阳性,8例患者有病理性SD-OCT征象。自体荧光在临床阶段受到影响，但不是在临床前阶段.在12例黄斑病中有4例，患者有病理性ERG结果。
结论：HCQ累积剂量之间的显着相关性，被认为是黄斑病变的主要危险因素，SD-OCT和10.2视野结果阳性，这两种测试的组合是Plaquenil黄斑病变筛查策略的基础。这些结果表明使用简化的筛选程序，包括年度SD-OCT和10.2视野，同时考虑累积剂量。多灶性ERG似乎比筛查更有助于诊断确认，尤其是临床前阶段.眼底自发荧光不是早期诊断的有效测试。
方法：104名长期服用羟氯喹的患者接受了眼科评估，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,和多病灶ERG，只要有可能,在一项前瞻性单中心研究中。
结果：HCQ累积剂量与SD-OCT和10.2视野阳性结果之间存在显著相关性（P<0.05）。高累积HCQ剂量与眼底检查阳性结果之间没有显着相关性，自发荧光,或多病灶ERG。健康组(946g)和黄斑病变组(1427g)的平均累积剂量差异有统计学意义(P<0.05)。184名患者中,发现12例毒性黄斑病变(患病率6.5%)。对于这12个案例，5在临床阶段被诊断出，7例诊断为临床前早期。10例患者视野呈阳性,8例患者有病理性SD-OCT征象。自体荧光在临床阶段受到影响，但不是在临床前阶段.在12例黄斑病中有4例，患者有病理性ERG结果。
结论：HCQ累积剂量之间的显着相关性，被认为是黄斑病变的主要危险因素，SD-OCT和10.2视野结果阳性，这两种测试的组合是Plaquenil黄斑病变筛查策略的基础。这些结果表明使用简化的筛选程序，包括年度SD-OCT和10.2视野，同时考虑累积剂量。多灶性ERG似乎比筛查更有助于诊断确认，尤其是临床前阶段.眼底自发荧光不是早期诊断的有效测试。
