应用OCTA检测羟氯喹对SLE患者黄斑区视网膜微血管形态的影响

Application of OCTA to Detect the Effect of Hydroxychloroquine on Retinal Microvascular Morphology in the Macular Region of SLE Patients

摘要: 目的：通过光学相干断层扫描血管成像(Optical Coherence Tomography Angiography, OCTA)检测口服羟氯喹(Hydroxychloroquine, HCQ)且无眼部症状的系统性红斑狼疮(Systemic Lupus Erythematosus, SLE)患者黄斑区视网膜微血管形态的情况，为早期诊断羟氯喹视网膜病变提供临床依据。方法：回顾性病例研究，将2024年5月至2024年11月于青岛大学附属医院风湿免疫科门诊就诊的53例(97眼) SLE患者的临床资料纳入研究。根据服用HCQ情况分为2组：低危组(服药累计时间 < 5 y) 26例50眼，高危组(服药累计时间 ≥ 5 y) 27例47眼。所有入组患者均进行OCTA、光学相干断层扫描(Optical Coherence Tomography, OCT)和自动化视野检查(Auto Visual Field, AVF)。运用OCTA技术测量中央凹无血管区(Foveal Avascular Zone, FAZ)的周长、面积及黄斑区三个区域的视网膜浅表毛细血管丛(Superficial Capillary Plexus, SCP)和深部毛细血管丛(Deep Capillary Plexus, DCP)的血管密度值，采用两独立样本的U检验比较低危组和高危组的差异，量化评估黄斑区视网膜HCQ毒性改变。结果：两组患者基线资料(年龄、视野)无统计学差异(P > 0.05)。与低危组相比，高危组中心凹、旁中心凹及周边区域的SCP血管密度均降低，FAZ的周长及面积均增加，差异均有统计学意义(均为P < 0.05)。两组间中心凹、旁中心凹及周边区域的DCP血管密度没有显著差异(均为P > 0.05)。结论：HCQ累计服药时间与FAZ的周长、面积和SCP血管密度显著相关，长期用药导致视网膜表层微血管发生改变。

Abstract: Objective: To evaluate retinal microvascular morphology in the macular region of systemic lupus erythematosus (SLE) patients undergoing hydroxychloroquine (HCQ) treatment without ocular symptoms, using optical coherence tomography angiography (OCTA). This study aims to establish a clinical foundation for the early diagnosis of hydroxychloroquine retinopathy by assessing retinal microvascular alterations in asymptomatic SLE patients. Methods: A retrospective case study was conducted on 53 SLE patients (97 eyes) who visited the outpatient clinic of the Department of Rheumatology and Immunology at the Affiliated Hospital of Qingdao University between May 2024 and November 2024. Patients were stratified into two groups based on HCQ usage: Low-risk group: 26 cases (50 eyes) with a cumulative HCQ duration of <5 years; High-risk group: 27 cases (47 eyes) with a cumulative HCQ duration of ≥5 years. All participants underwent comprehensive assessments, including optical coherence tomography (OCT), OCTA, and automated visual field (AVF) testing. OCTA was utilized to quantify the circumference and area of the foveal avascular zone (FAZ), as well as the vascular density of the superficial capillary plexus (SCP) and deep capillary plexus (DCP) within the macular region. Statistical comparisons between the low-risk and high-risk groups were performed using the U-test for two independent samples to evaluate retinal HCQ toxicity. Results: Baseline characteristics, including age and visual field parameters, did not differ significantly between the two groups (P > 0.05). The high-risk group demonstrated a significant reduction in SCP vessel density in the central, paracentral, and peripheral macular regions compared to the low-risk group (all P < 0.05). Additionally, the high-risk group exhibited a significant enlargement in both the circumference and area of the FAZ (all P < 0.05). No significant differences were observed in DCP vessel density across the central, paracentral, or peripheral regions between the two groups (all P > 0.05). Conclusion: Cumulative HCQ exposure was significantly associated with alterations in the FAZ (circumference and area) and SCP vessel density. Prolonged HCQ administration induced microvascular changes predominantly in the superficial retinal layer, underscoring the necessity of monitoring these parameters for the early detection of HCQ-induced retinopathy.