Purpose

Multifocal electroretinogram (mfERG) shows great utility as a screening tool to detect early hydroxychloroquine (HCQ) retinopathy, but its widespread use is limited by the lack of accessibility and long test duration. In this study, we evaluated a novel concentric 5-ring mfERG stimulus to provide a simplified and rapid protocol for screening HCQ toxicity.

Methods

Patients referred for HCQ retinopathy screening were consented to this observational cross-sectional study. Patients with amblyopia, high refractive error (more than 8 diopters), other retinal diseases precluding appropriate evaluation or history of retinal surgery were excluded. The data were collected from patients undergoing HCQ screening at a single center from July 2019 to March 2020. Patients were tested with the new concentric 5-ring mfERG stimulus, standard 61-hexagon mfERG stimulus, spectral domain optical coherence tomography and automated 10-2 visual fields. For the main outcome, the 5-ring mfERG was compared to 61-hexagon stimulus to determine the time-to-test completion and assess the association between ring (R1–R5) amplitude and ring ratio compared against cumulative dose, dose by real body weight and duration of therapy using Pearson correlation.

Results

In total, 52 patients (104 eyes; 5 males and 47 females) were recruited with a mean age of 59 years (range 23–85 years). The 5-ring protocol was markedly quicker to perform (1.3 ± 0.2 min; mean (SD)) compared to the 61-hexagon protocol (5.2 ± 0.6 min), p < 0.0001; n = 10 patients. The new R2/R5 ring ratio showed a moderate correlation with daily dose (r = − 0.640), cumulative dose (r = − 0.581) and duration of therapy (r = − 0.417). Similar correlations were observed with the new R2/R4 ring ratio which were not significantly different from the new R2/R5 correlation coefficients. The new R2/R5 ring ratio demonstrated a stronger correlation with daily (p = 0.002) and cumulative dose (p = 0.0001) compared to the 61-hexagon stimulus.

Conclusions

In this exploratory study, our novel 5-ring mfERG protocol significantly shortened data acquisition time while providing comparable results to the standard 61-hexagon stimulus for detecting HCQ-induced electrophysiological changes that are correlated with HCQ dosages and treatment duration. Our protocol has the potential to be more clinically practical by simplifying routine screening.

中文翻译：

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一种用于检测羟氯喹视网膜毒性的新型 5 环多焦视网膜电图刺激

目的

多焦视网膜电图 (mfERG) 作为检测早期羟氯喹 (HCQ) 视网膜病变的筛查工具显示出极大的实用性，但其广泛使用受到缺乏可及性和测试持续时间长的限制。在这项研究中，我们评估了一种新的同心 5 环 mfERG 刺激，以提供一种简化和快速的方案来筛选 HCQ 毒性。

方法

转诊进行 HCQ 视网膜病变筛查的患者同意这项观察性横断面研究。弱视、高屈光不正（超过 8 度屈光度）、其他无法进行适当评估的视网膜疾病或有视网膜手术史的患者被排除在外。数据收集自 2019 年 7 月至 2020 年 3 月在单一中心接受 HCQ 筛查的患者。 患者接受了新的同心 5 环 mfERG 刺激、标准 61 六边形 mfERG 刺激、光谱域光学相干断层扫描和自动 10-2视野。对于主要结果，将 5 环 mfERG 与 61 六边形刺激进行比较，以确定测试完成时间并评估环（R1-R5）振幅和环比与累积剂量之间的关联，

结果

总共招募了 52 名患者（104 只眼；5 名男性和 47 名女性），平均年龄为 59 岁（范围 23-85 岁）。与 61 六边形协议 (5.2 ± 0.6 分钟) 相比，5 环协议的执行速度明显更快 (1.3 ± 0.2 分钟；平均值 (SD))，p  < 0.0001；n  = 10 名患者。新的 R2/R5 环比显示出与日剂量 ( r  = − 0.640)、累积剂量 ( r  = − 0.581) 和治疗持续时间 ( r  = − 0.417)的中等相关性。新的 R2/R4 环比与新的 R2/R5 相关系数没有显着差异，观察到类似的相关性。新的 R2/R5 环比显示出与每日 ( p  = 0.002) 和累积剂量 (p  = 0.0001) 与 61 六边形刺激相比。

结论

在这项探索性研究中，我们的新型 5 环 mfERG 协议显着缩短了数据采集时间，同时提供了与标准 61 六边形刺激相当的结果，用于检测与 HCQ 剂量和治疗持续时间相关的 HCQ 诱导的电生理变化。通过简化常规筛查，我们的方案有可能在临床上更加实用。