Objective

To investigate macular ganglion cell complex (GCC) and peripapillary retinal nerve fiber layer (RNFL) thicknesses in patients with hydroxychloroquine retinopathy of differing severity.

Design

Cross-sectional, case-control comparison study.

Participants

From patients screened for hydroxychloroquine retinopathy between January 2016 and October 2021 using swept-source optical coherence tomography (SS-OCT), fundus autofluorescence (FAF), and standard automated perimetry, 66 patients with retinopathy and 66 without retinopathy were included by 1:1 propensity score matching based on age, sex, systemic diseases, history of tamoxifen and pentosan use, and kidney disease.

Methods

Eyes with hydroxychloroquine retinopathy were divided into early, moderate, and severe stages. Inner-retinal thickness parameters, including macular GCC (RNFL + ganglion cell layer + inner plexiform layer) and peripapillary RNFL thicknesses, were automatically obtained using SS-OCT (DRI-OCT Triton, Topcon Inc., Japan) and compared between patients with and without retinopathy and between severity subgroups. The structure-function relationships between GCC or peripapillary RNFL thicknesses and perimetric parameters including mean deviation (MD) and visual field index (VFI) of Humphrey 30-2 test were evaluated.

Main Outcome Measures

Macular GCC and peripapillary RNFL thickness parameters.

Results

The average macular GCC and peripapillary RNFL thicknesses were significantly decreased in patients with hydroxychloroquine retinopathy relative to those without retinopathy. Macular GCC thicknesses in 4 of 6 macular sectors and peripapillary RNFL thicknesses in 9 of 12 clock-hour sectors were significantly different between the groups. The differences in the average and sectoral macular GCC parameters were statistically significant among the severity subgroups, particularly between severe and earlier stages. Average macular GCC and peripapillary RNFL thicknesses significantly correlated with MD and VFI in all patients (all P < .001).

Conclusions

Macular GCC and peripapillary RNFL thinning was more prominent in eyes with severe hydroxychloroquine retinopathy, as indicative of inner-retinal thinning in eyes with advanced-stage disease. Further, as inner-retinal thinning showed a significant correlation with worse perimetric function, cautious evaluation of the inner retina may be required for eyes with advanced hydroxychloroquine retinopathy.

中文翻译：

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羟氯喹视网膜病变中的黄斑神经节细胞复合体和视盘周围视网膜神经纤维层厚度

客观的

研究不同严重程度的羟氯喹视网膜病变患者的黄斑神经节细胞复合体 (GCC) 和视盘周围视网膜神经纤维层 (RNFL) 厚度。

设计

横断面病例对照比较研究。

参加者

从 2016 年 1 月至 2021 年 10 月期间使用扫描源光学相干断层扫描 (SS-OCT)、眼底自发荧光 (FAF) 和标准自动视野检查筛查羟氯喹视网膜病变的患者中，66 名视网膜病变患者和 66 名无视网膜病变患者按 1:1 的比例纳入基于年龄、性别、全身性疾病、他莫昔芬和戊聚糖使用史以及肾脏疾病的倾向评分匹配。

方法

患有羟氯喹视网膜病变的眼睛分为早期、中度和重度阶段。内视网膜厚度参数，包括黄斑 GCC（RNFL + 神经节细胞层 + 内丛状层）和视盘周围 RNFL 厚度，使用 SS-OCT（DRI-OCT Triton，Topcon Inc.，Japan）自动获得，并在患有和没有视网膜病变和严重程度亚组之间。评估了 GCC 或视乳头周围 RNFL 厚度与周边参数（包括 Humphrey 30-2 试验的平均偏差 (MD) 和视野指数 (VFI)）之间的结构-功能关系。

主要观察指标

黄斑 GCC 和周围毛细血管 RNFL 厚度参数。

结果

与没有视网膜病变的患者相比，羟氯喹视网膜病变患者的平均黄斑 GCC 和视乳头周围 RNFL 厚度显着降低。6 个黄斑区中的 4 个中的黄斑 GCC 厚度和 12 个时钟小时区中的 9 个中的视乳头周围 RNFL 厚度在各组之间存在显着差异。平均和部门黄斑 GCC 参数的差异在严重程度亚组中具有统计学意义，特别是在严重和早期阶段之间。所有患者的平均黄斑 GCC 和视乳头周围 RNFL 厚度与 MD 和 VFI 显着相关（所有P < .001）。

结论

黄斑 GCC 和视盘周围 RNFL 变薄在患有严重羟氯喹视网膜病变的眼中更为突出，表明患有晚期疾病的眼内视网膜变薄。此外，由于内层视网膜变薄与较差的周边功能显着相关，因此对于患有晚期羟氯喹视网膜病变的眼睛，可能需要对内层视网膜进行谨慎评估。