| Objective:The changes in retinal structure and microcirculation before visual impairment in patients with long-term hydroxychloroquine treatment of systemic lupus erythematos-us were detected by the application of swept source optical coherence tomography angiography,and the effect of systemic lupus erythematosus on the retina was explored by comparing patients with systemic lupus erythematosus and healthy people.Method:A retrospective case control study.From March 2022 to January 2023,80patients(80 eyes)with systemic lupus erythematosus who regularly took hydroxychl-oroquine in the outpatient clinic of the First Affiliated Hospital of Nanchang University were collected,of which 7 cases were excluded due to other eye diseases and visual impairment and visible retinopathy after taking drugs,and the remaining73 cases(73 eyes)were used as the group of patients with systemic lupus erythematosus and 21 cases(21 eyes)were used as the control group.The group of patients with systemic lupus erythema-atosus was divided into a baseline group(6months ≤Duration of medication<1 year),a low-risk group(1 year ≤Duration of medication<5 years),and a high-risk group(Duration of medication≥ 5 years)based on the duration of treatment with hydroxychloroquine(hydroxychloro-quine course of treatment).All subjects included in the study underwent binocular scanning source optical coherence tomography angiography(macular region 6mm*6mm),insert optometry,non-contact intraocular pressure measurement,computer visual field detection,micro visual field,and fundus autofluorescence examination.Based on the analysis of the patient’s binocular examination results,if no visual function damage occurred in both eyes,the left eye examination data were selected for recording and analysis,otherwise,the visual function test for normal eyes was selected.At the same time,the patient’s basic information,the course of systemic lupus erythematosus,glucocort-icoid medication,daily dose of hydroxychloroquine,course of treatment of hydroxychloroquine,calculation of cumulative dose of hydroxychloroquine,SLEDAI score,and peripheral blood hydroxychloroquine concentration were recorded.Under the condition that the best corrected visual acuity,intraocular pressure,fundus fluorescein angiography,visual field,and micro visual field examinations are normal,the effects of different hydroxychloroquine(course of treatment,cumulative dose,and concentration)on the inner retinal thickness(ILM-IPL),outer retinal thickness(INL-RPE),full retinal thickness(ILM-RPE),Foveal avascular zone area,and Foveal avascular zone perimeter in each region of the patient’s macular region were analyzed "The effect of superficial retinal capillary blood flow density.".Result:1.Among the 73 patients in the systemic lupus erythematosus group,21 patients(21 eyes)in the baseline group,23 patients(23 eyes)in the low-risk group and 29patients(29 eyes)in the high-risk group.The duration of systemic lupus erythema-atosus and the cumulative dose of hydroxychloroquine in the high-risk group were higher than those in the low-risk group and the baseline group,respectively: the duration of systemic lupus erythematosus(month): 11.00(8.00,12.00)vs39.00(29.00,48.00)vs96.00(73.00,120.00)(H=59.301,P<0.001),Cumulative dose of hydroxy-chloroquine(g):96.00(72.00,138.00)vs288.00(216.00,468.00)vs666.00(414.00,792.00)(H=52.861,P < 0.001);The daily dose of hydroxychloroquine in the high-risk group was lower than that in the low-risk group and the baseline group,respectively: daily dose of hydroxychloroquine(mg): 400.00(300.00,400.00)vs400.00(200.00,400.00)vs200.00(200.00,350.00)(H=12.873,P=0.002).There was no significant difference in SLEDAI score,hydroxychloroquine concentration,hormone administration and hormone dose among the groups(P>0.05).2.The thickness parameters of the inner retina of the fovea,the inner retina of the parafovea and the outer retina of the three regions in the healthy group(21 eyes)were higher than those in the 73 patients(73 eyes)with systemic lupus erythematosus(SLE),The difference between the two groups was statistically significant(P<0.05),while the difference between the thickness of the inner retina in the surrounding region and the thickness of the full-thickness retina in each region was not significant(P>0.05).3.The average,foveal,lower and outer superficial vascular density of 21patients(21 eyes)in the healthy group was higher than that of 73 patients(73 eyes)in the systemic lupus erythematosus group,and the area and circumference of Foveal avascular zone were lower than those in the SLE group.The difference between the two groups was statistically significant(P<0.05);However,there was no significant difference in blood flow density between the temporal side of the inner circle,the nasal side of the inner circle and the superficial layer above the inner circle(P>0.05).4.The inner retinal thickness and whole retinal thickness parameters in the central recess area in each region in the high-risk group were lower than those in the baseline and low-risk groups,and the differences were statistically significant(P<0.05),whereas the differences in the outer retinal thickness and whole retinal thickness parameters in the paracentral recess and peripheral regions in each region were not statistically significant(P>0.05).5.The macular area(6mm*6mm)central recess area,temporal side of the outer circle,upper outer circle and mean superficial retinal capillary density were lower in the high-risk group than in the baseline and low-risk groups,and the difference was statistically significant at P<0.05.And the Foveal avascular zone area and circumference were higher in the high-risk group than in the baseline and low-risk groups,and the difference was statistically significant at P<0.05.6.The analysis of correlation shows the length of systemic lupus erythematosus,the course of hydroxychloroquine and the cumulative dose of hydroxychloroquine were negatively correlated with the inner retinal thickness of the three regions and the full retinal thickness of the fovea(P<0.05);and negatively correlated with Mean superficial blood flow density in the fovea,temporal side of inner circle,upper part of inner circle,temporal side of outer circle,and upper part of outer circle(P<0.05);but positive correlation with Foveal avascular zone area and perimeter(P<0.05).However,the course of systemic lupus erythematosus(SLE),hydroxychlor-oquine(course of treatment,cumulative dose)and the thickness of the outer retina in the three regions,the thickness of the whole retina in the parafovea and surrounding regions,and the superficial blood flow density in the nasal and lower regions were not correlated.The daily dose of hydroxychloroquine and the concentration of hydroxychloroquine in the peripheral blood were not correlated with the thickness of the retinal membrane in each region,the superficial blood flow density in each region,the area of Foveal avascular zone,and the circumference of Foveal avascular zone.7.The results of multiple linear regression analysis showed that the cumulative dose of hydroxychloroquine was a risk factor for changes in the thickness of the inner retina of the macular area,the superficial retinal blood flow density of the fovea,the area of Foveal avascular zone and the circumference(B<0,P<0.05),and the course of systemic lupus erythematosus was a risk factor for changes in the superficial retinal blood flow density of the fovea and outer temporal retina(B<0,P<0.05).However,the course of systemic lupus erythematosus and hydroxychloroquine accumulation agent had no effect on the temporal,upper and upper superficial blood flow density of the inner circle(P>0.05),and the concentration of hydroxychloroquine had no effect on the inner retinal thickness,fovea,temporal,upper,outer temporal,upper superficial blood flow density,Foveal avascular zone area and circumference of the macular area(P>0.05).Conclusion:Through the analysis of optical coherence tomography angiography,The duration of systemic lupus erythematosus has adverse effects on retinal blood flow;long-term hydroxychloroquine treatment had adverse effects on the inner retina,superficial retinal blood flow density and unvascular area of the macular fovea in patients with subclinical systemic lupus erythematosus without visual impairment.The regular examination of optical coherence tomography angiography has certain significance in protecting the visual function of patients treated with hydroxychloro-quine for a long time,and also provides an objective basis for retinal changes in subclinical patients. |
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