目的:回顾对氯喹和羟氯喹治疗患者采用新的随访方案后发现的问题。
方法:在2012年5月至2013年1月期间对临床档案进行了回顾性研究,视网膜图,眼底自动荧光(FAF)图像,以及在开始使用羟氯喹治疗时转诊到眼科的患者的中央10度视野(VF)。
结果:纳入126例患者;94.4%从风湿科转诊,5.6%从皮肤科转诊。平均年龄为59.7岁,73.8%是女性。他们都在用羟氯喹治疗,300mg是最常见的日剂量。类风湿性关节炎是最常见的诊断(40.5%),其次是系统性红斑狼疮(15.9%)。Snellen的平均视力为0.76,26例患者有晶状体混浊。97例患者VF正常,8有轻度至中度缺陷,没有明确的模式,在9中,结果不可靠。在65岁以上的51名患者中,16人(31.4%)的VF改变或不可靠。104例(82.5%)患者FAF正常,异常,但与检眼镜特征一致,在12例患者中(病理性近视,年龄相关的变化,早期,中晚期年龄相关性黄斑变性)。
结论:对于65岁以上的患者,作为诊断AP毒性的参考测试,视野并不十分可靠。因此,建议将FAF作为主要测试,也许与另一个客观测试相结合,例如SD-OCT而不是VF。
OBJECTIVE: To review the problems found after a new follow-up protocol for patients on chloroquine and hydroxychloroquine treatment.
METHODS: Retrospective study was conducted between May 2012 and January 2013 on the clinical files, retinographies, fundus auto-fluorescence (FAF) images, and central-10 degree visual fields (VF) of patients who were referred to the Ophthalmology Department as they had started treatment with hydroxychloroquine.
RESULTS: One hundred twenty-six patients were included; 94.4% were referred from the Rheumatology Department and 5.6% from Dermatology. Mean age was 59.7 years, and 73.8% were women. All of them were on hydroxychloroquine treatment, and 300mg was the most frequent daily dose. Rheumatoid arthritis was the most common diagnosis (40.5%), followed by systemic lupus erythematosus (15.9%). The mean Snellen visual acuity was 0.76, and 26 patients had lens opacities. The VF were normal in 97 patients, 8 had mild to moderate defects with no definite pattern, and in 9 the results were unreliable. Of the 51 patients older than 65years, 16 (31.4%) had altered or unreliable VF. The FAF was normal in 104 patients (82.5%), and abnormal, but consistent with ophthalmoscopic features, in 12 patients (pathological myopia, age related changes, early, middle or late age-related macular degeneration).
CONCLUSIONS: Visual fields as a reference test for the diagnosis of AP toxicity are not quite reliable for patients over 65. Therefore, the FAF is recommended as primary test, perhaps combined with another objective test, such as SD-OCT instead of VF.