自适应光学眼底成像对临床前期羟氯喹性视网膜病变的研究  

Study on adaptive optics fundus imaging in pre-clinical hydroxychloroquine retinopathy

作　　者：刘桦 朱志鸿 黄厚斌 陈文姬[4] 樊立娜[4] 莫世衍 Liu Hua;Zhu Zhihong;Huang Houbin;Chen Wenji;Fan Lina;Mo Shiyan(The Second School of Clinical Medicine,Southern Medical University,Guangzhou 510515,China;Department of Ophthalmology,Hainan Hospital of PLA General Hospital,Sanya 572013,China;Senior Department of Ophthalmology,PLA General Hospital,Beijing 100853,China;Department of Rheumatism and Immunology,Hainan Hospital of PLA General Hospital,Sanya 572013,China)

机构地区：[1]南方医科大学第二临床医学院,广州510515 [2]解放军总医院海南医院眼科,三亚572013 [3]解放军总医院眼科医学部,北京100853 [4]解放军总医院海南医院风湿免疫科,三亚572013

出　　处：《中华眼底病杂志》2023年第9期747-753,共7页Chinese Journal of Ocular Fundus Diseases

基　　金：军队后勤科研项目保健专项课题(23BJZ37);海南省卫生健康行业科研项目(22A200351)。

摘　　要：目的应用自适应光学(AO)眼底成像评估羟氯喹(HCQ)性视网膜病变临床前期患者视锥细胞的改变。方法回顾性病例对照研究。2020年5~7月于解放军总医院海南医院风湿免疫科就诊的风湿免疫性疾病患者46例(病例组)纳入研究。患者均有HCQ用药史且眼底检查未见明显异常。选取同期人口学特征匹配的健康志愿者105名作为对照组。受检者均行最佳矫正视力(BCVA)、频域光相干断层扫描(SDOCT)、眼底自身荧光(FAF)、视野、角膜内皮镜检查以及眼轴长度(AL)测量。BCVA检查采用Snellen视力表进行,统计时换算为最小分辨角对数(logMAR)视力。病例组46例中,男性6例,女性40例;年龄(42.02±13.81)岁;logMARBCVA0.063±0.015;AL(23.95±0.726)mm。视野、黄斑SD-0CT、FAF检查未见异常。HCQ平均累积剂量为522.60(61728)g。采用rtx1AO视网膜照相机采集受检者双眼距离中心凹3°离心率的视网膜上方、鼻侧、下方、侧四个象限的眼底图像。测量4个象限中视锥细胞密度、间距、排列规则度和与之相邻的距离最近的视锥细胞个数为6的视锥细胞(nn=6)所占比例。病例组、对照组受检者左右眼之间视锥细胞密度比较行配对t检验;各象限视锥细胞密度、间距比较行两独立样本t检验。结果与对照组比较,病例组左眼四个象限和右眼鼻侧、上方、下方视锥细胞密度明显降低,差异有统计学意义(t=4.247、2.107、4.884、2.254、2.643、4.445、4.116,P<0.05)。病例组受检者左眼鼻侧、题侧视锥细胞间距较对照组左眼明显增大,差异有统计学意义(t=2.750、3.318,P<0.05)。与对照组比较,病例组右眼、左眼题侧视锥细胞排列规则度显著降低,差异有统计学意义(P=0.002、0.011);病例组右眼下方、侧nn=6所占比例明显下降,差异有统计学意义(P=0.006、0.032)。结论AO眼底成像可以发现HCQ性视网膜病变临床前期视锥细胞即已发生改变。Objective To evaluate whether there are changes in cone cells in patients with pre-clinical hydroxychloroquine(HCQ)retinopathy using an adaptive optics(AO)retinal camera.Methods A retrospective case-control study.From May 2020 to July 2020,46 patients who were treated in Department of Rheumatism and Immunology,Hainan Hospital of PLA General Hospital with rheumatic immune diseases were included.All patients had a history of HCQ use and no obvious abnormality was found in fundus examination;105 healthy people with similar demographic characteristics without a history of hydroxychloroquine were recruited as the control group were included.All subjects received the routine ophthalmological examination including best corrected visual auity(BCVA),spectral-domain optical coherence tomography(SD-OCT),Fundus autofluorescence(FAF),visual field,endoscopy of the cornea,and the measurement of axial length(AL).The BCVA was performed with the Snellen visual acuity chart,and the result was converted to logarithmic minimum angle of resolution(logMAR)visual acuity for statistic.Among the 46 cases,6 cases were males and 40 cases were females.Age was(42.02±13.81)years old;logMAR BCVA was 0.063±0.015;AL was(23.95±0.726)mm.Visual field,macular SD-OCT,FAF examination showed no abnormality.The average cumulative dose of HCQ was 522.60(6-1728)g.rtx1 AO retinal camera was used to collect fundus images of subjects in four quadrants above the retina,nasal side,lower side and temporal side with 3°centrifugation from the fovea in both eyes.The cone density,cone spacing,cone arrangement regularity and the proportion of the nearest cones with 6(nn=6)were measured in the four quadrants.The density of cone cells between the left and right eyes in case group and control group were compared by paired t test.The density and spacing of cone cells in each quadrant were compared by t test of two independent samples.Results Compared with the control group,the cone cell density in the four quadrants of the left eye and the nasal,superior and inferior

关 键 词：羟氯喹性视网膜病变 临床前期 视锥细胞 自适应光学眼底成像 

分 类 号：R774.1[医药卫生—眼科]