应用10-2视野评估硫酸羟氯喹对中心视敏度的影响

Effect of hydroxychloroquine sulfate on central visual acuity detected by 10-2 Visual Field system

目的探讨应用10-2视野检查评估硫酸羟氯喹对中心视网膜敏感度的影响,为临床用药提供指导依据。方法回顾性分析2019年1月1日-2020年1月20日于解放军总医院第一医学中心眼科门诊就诊的139例结缔组织病患者的临床资料。根据服用硫酸羟氯喹情况分为4组:A组(未服药)26例52眼,B组(服药两年内)47例93眼,C组(服药2~5年)31例62眼,D组(服药5年以上)35例69眼。结合最佳矫正视力(best corrected visual acuity,BCVA)分析各组10-2视野检查中平均缺损情况。结果四组的BCVA:A组0.93±0.19,B组0.92±0.16,C组0.91±0.20,D组0.87±0.17,组间差异无统计学意义(F=1.498,P=0.215)。10-2视野平均缺损:A组(-1.63±1.27)dB,B组(-2.10±1.44)dB,C组(-2.44±1.12)dB,D组(-2.98±1.90)dB,四组间比较差异有统计学意义(F=9.207,P=0.000),组间两两比较,C组显著低于A组,D组显著低于其他三组(P均<0.05)。结论患者服用硫酸羟氯喹后,视网膜中心视敏度下降,且随着服药时间增加呈加重趋势,尤其是服药5年以上的患者。10-2视野检查能够在中心视力发生改变之前检测出羟氯喹影响下视网膜早期功能性的改变,可为临床长期用药提供有效指导。

Objective To evaluate the adverse effect of hydroxychloroquine sulfate on the sensitivity of the central retina detected by 10-2 visual field examination,so as to provide guidance for clinical medication.Methods Clinical data about 139 patients with connective tissue disease visited the ophthalmology department of the First Medical Center of Chinese PLA General Hospital from January 1,2019 to January 20,2020 were retrospectively analyzed.The patients were divided into four groups according to the history of using hydroxychloroquine:group A(without medication,26 cases,52 eyes);group B(taking medicine for 2 years,47 cases,93 eyes);group C(taking medicine for 2 to 5 years,31 cases,62 eyes)and group D(taking medicine for more than 5 years,35 cases,69 eyes).The effect of hydroxychloroquine sulfate on the sensitivity of the central retina was evaluated by measuring and analyzing the mean defect(MD)in combination with visual acuity in the four groups using 10-2 visual of field.Results The best corrected visual acuity of the group A,B,C,D was 0.93±0.19,0.92±0.16,0.91±0.20 and 0.87±0.17,respectively,without significant difference(F=1.498,P=0.215).The mean defect of 10-2 visual field in the four groups was(-1.63±1.27)dB,(-2.10±1.44)dB,(-2.44±1.12)dBand(-2.98±1.90)dB,and the overall differences between these groups were significant(F=9.207,P=0.000);the mean defect of 10-2 visual field in group C was significantly lower than that in group A,and it was significantly lower in group D than in group A,group B,group C.Conclusion After taking hydroxychloroquine sulfate,the sensitivity of central retina decreases,and it shows an aggravating trend over time,especially for patients who had taken the medicine for more than five years.10-2 visual field examination can detect the early functional changes induced by hydroxychloroquine on retina sensitively before the central vision changes,which can provide effective guidance for long-term clinical drug use.