应用光学相干断层扫描仪检测羟氯喹对视神经纤维层的影响分析

目的通过光学相干断层扫描仪(OCT)检测服用羟氯喹(HCQ)的风湿病患者的视神经纤维层(RNFL)厚度和形态学,分析HCQ对视神经纤维的影响,以及OCT在早期发现羟氯喹性视网膜病变中的作用。方法将观察对象50例(100眼)按服药时间长短分成两组,与正常健康者25例(50眼)通过OCT检查比较各象限RNFL厚度。此外对所有患者均进行眼科常规检查包括视力、眼压、色觉、裂隙灯、眼底、视野检查。结果短期服药组RNFL厚度:颞侧(92.76±17.09)μm,下方(135.48±19.15)μm,鼻侧(88.15±20.25)μm,上方(139.48±21.50)μm,RNFL均值为(111.26±15.36)μm。长期服药组:颞侧(94.65±17.14)μm,下方(135.47±19.14)μm,鼻侧(91.17±20.23)μm,上方(140.44±21.57)μm,RNFL均值(113.22±14.16)μm。对照组:颞侧(96.17±16.50)μm,下方(139.18±14.78)μm,鼻侧(91.66±14.72)μm,上方(141.19±18.87)μm,均值为(117.21±10.45)μm。服用HCQ 100只眼中0.04%为RNFL稀疏缺损。短期组、长期组和对照组之间相比RNFL厚度和形态学无明显变化。结论通过OCT扫描测量视盘周围RNFL厚度和形态学,无论是短期服用还是长期服用HCQ,HCQ对视神经纤维层厚度和形态学影响不明显。羟氯喹性视网膜病变发病率低,OCT在早期发现羟氯喹性视网膜病变的作用仍需研究。

Objective To investigate the ffect of hydroxychloroquine treatment on the theumatic patients whose RNFL thickness and morphology is measured by OCT,and the value of OCT examination in the early diagnosis of hydroxychloroquine retinopathy.Methods Fifty patients(100 eyes)were divided into two groups according to the length of medication,and 25 patients(50 eyes)with normal health were compared by the OCT examination for the thickness of each quadrant RNFL thickness.In addition,all patients underwent routine eye examinations including vision,intraocular pressure,color vision,slit lamp,fundus,and visual field examination.Results RNFL thickness with short-time hydroxychloroquine treatment were as follows:temporal(92.76±17.09)μm,inferior(135.48±19.15)μm,nasal(91.17±20.23)μm,superior(140.44±21.57)μm,and the average was(111.26±15.36)μm.RNFL thickness with long-time hydroxychloroquine treatment were as follows:temporal(94.65±17.14)μm,inferior(135.47±19.14)μm,nasal(91.17±20.23)μm,superior(91.17±20.23)μm,and the average was(113.22±14.16)μm.RNFL thickness without hydroxychloroquine treatment were as follows:temporal(96.17±16.50)μm,inferior:(139.18±14.78)μm,nasal(91.66±14.72)μm,superior(141.19±18.87)μm,and the average was(117.21±10.45)μm.In the 100 eyes of HCQ group there were 0.04%sparse like RNFL defect.There was no significant change in RNFL thickness and morphology between the short-term,long-term,and control groups.Conclusion Through this research,hydroxychloroquine has no significant effect on RNFL thickness and morphology measured by OCT scan,whether it is taken for a short period of time or long-term use of hydroxychloroquine.The incidence of hydroxychloroquine retinopathy is low,and the role of OCT in the early detection of hydroxychloroquine retinopathy remains to be studied.