羟氯喹视网膜病变发病机制及相关眼底改变的研究进展

Research progress on the pathogenesis of hydroxychloroquine retinopathy and the related fundus changes

羟氯喹视网膜病变是在长期或过量使用羟氯喹后出现的一种眼部病变。该病变早期临床表现无特异性,常在疾病晚期发生严重的中心视力损伤时才被发现。其发病机制主要包括羟氯喹具有促黑色素性、诱导视网膜色素上皮变性、亲溶酶体作用及干扰视觉周期。近年来,随着视网膜成像技术的发展及对羟氯喹视网膜病变的深入研究,在早期阶段可出现视网膜和脉络膜厚度及血管等特征性的眼底结构改变。这不仅为羟氯喹视网膜病变的早期诊断提供了重要依据,也为探索其发病机制提供了重要线索。临床医生熟练掌握相关的眼底改变和发病机制,将有助于早期诊断和治疗,同时也能最大程度地避免患者发生不可逆的中心视力损伤。

Hydroxychloroquine retinopathy is an ocular lesions that develops following long-term or excessive use of hydroxychloroquine.The early clinical presentation of this lesion is nonspecific and is often detected when severe central vision impairment occurs in late stage.It currently mainly includes hydroxychloroquine binding to melanin,inducing degeneration of the retinal pigment epithelium,increasing the pH of lysosomes in the retinal pigment epithelium and interfering with the visual cycle.In recent years,with the development of retinal imaging technology and the in-depth study of hydroxychloroquine retinopathy,characteristic fundus structural changes such as retinal and choroidal thickness and blood vessels may occur in the early stage.This not only provides an important basis for the early diagnosis of hydroxychloroquine retinopathy,but also provides important clues for investigating its pathogenesis.Clinicians'proficiency in relevant fundus changes and pathogenesis will facilitate early diagnosis and treatment,while also minimizing irreversible central vision impairment in patients.