羥氯奎寧引起的視網膜病變在風濕免疫病患的影響：回溯性研究

Hydroxychloroquine Retinopathy in Patients With Rheumatic Diseases: A Retrospective Study

目的：探討使用羥氯奎寧的風濕免疫疾病病患其發生視網膜病變的表現及羥氯奎寧毒性所導致的視網膜病變可能的相關性。方法：本研究為病歷回朔性研究，蒐集比較58位自2000年至2020年使用羥氯奎寧的風濕免疫疾病病患在治療過程中，有發生視網膜病變的比例，回溯內容以病患是否經眼科診斷有羥氯奎寧所造成的視網膜病變為主，記錄病患的風濕疾病並且評估病患年齡、羥氯奎寧二十年內使用累積劑量的多寡、以及治療時間長短是否與視網膜病變發生機率有關。研究中之不正常的視網膜報告以及視野缺損經由眼科醫師判定疑為羥氯奎寧引發之視網膜病變。數據分析以multivariable logistic regressionanalysis分析上述相關獨立因子是否與眼睛異常表現相關。結果：統計上並未見到探討的因子與羥氯奎寧引起的視網膜病變有顯著意義的發現，但是在這些病人仍可見到眼睛檢查上的異常，以黃斑部反射減少及視野上的缺損所佔比例最大。一位患者診斷有羥氯奎寧所造成的視網膜病變。結論：儘管目前各項研究顯示羥氯奎寧相對而言是副作用較少的免疫調節劑，但仍須注意其對於視網膜可能產生的毒性，而需例行安排病人做眼睛檢查。

Objectives: To investigate hydroxychloroquine (HCQ) use in patients with rheumatic diseases at rheumatology outpatient departments and the possible occurrence of retinal changes, which may be related to HCQ toxicity. Materials and Methods: Medical records of 58 patients with rheumatic diseases and a history of HCQ use and who had ophthalmological evaluations were obtained from the database of Keelung Chang Gung Memorial Hospital. The type of rheumatic disease, patient age, duration of HCQ treatment, and cumulative HCQ dose over 20 years were recorded. Abnormal retinal examination findings and visual field defects raised suspicious of HCQ retinal toxicity. Logistic regression was used to evaluate whether the abnormal eye examination findings were related to age, HCQ use duration, or cumulative dose. Results: Among the patients, 31% had abnormal eye exam findings, such as decreased light reflex of the macula and visual field defects; these defects mentioned above were the most common ones in our patients collected. One case of HCQ retinopathy was diagnosed. No significant differences were observed between variables such as age, duration of HCQ use, and cumulative HCQ dose. Conclusion: Although HCQ is a relatively safe form of immunomodulatory therapy, the risk of retina toxicity should still be considered. Abnormal eye examination findings in our patients were not uncommon; further study is required to determine the importance of our findings and clinical implications. Ophthalmological evaluation of the retina at baseline and at follow-up in patients with long-term HCQ use should be performed to monitor HCQ-related retinopathy in a timely manner.