Her rheumatologist instructed her to undergo a baseline ocular examination prior to initiating Plaquenil (hydroxychloroquine, Sanofi-Aventis) therapy. Toxic maculopathy associated with chloroquine use was first documented in the literature five decades ago.1 In the United States, Plaquenil––an analog to chloroquine––is used to treat a variety of conditions, including rheumatoid arthritis, lupus and several distinct inflammatory disorders. Although the incidence of macular toxicity is infrequent with Plaquenil use (at a dosage of 200mg or 400mg q.d.), its visual impact can be devastating. Images early plaquenil toxicity fundus autoflurouecense Hydroxychloroquine plaquenil outcome for lupus patients Can you take plaquenil before surgery Causes of Bull's Eye maculopathy include cone dystrophy. cone-rod dystrophy. chloroquine or hydroxychloroquine toxicity. ceroid lipofuscinosis. Stargardt's and fundus flavimaculatus. fenestrated sheen macular dystrophy. parafoveal atrophy of RPE secondary to AMD. Nov 01, 2015 The incidence of retinal toxicity is associated with the cumulative dose of the drug, increasing significantly beyond 1,000 g of HCQ. This cumulative dose is created when the common dose of 400 mg/day is used for 6.8 years. Hydroxychloroquine is metabolized and secreted by both the liver and the kidneys. Sep 29, 2015 Background/Purpose The risk of end-stage retinopathy bull’s eye maculopathy from hydroxychloroquine HCQ is low 0.65%, Wolfe and Marmor, 2010. With recent advances in retinal structure and function testing, early changes on optical coherence tomography OCT, fundus autoflourescence FAF, multifocal electroretinography mfERG, and microperimetry MP are being used to detect early. Initially, central visual acuity may be unaffected, but the patient may notice related paracentral scotomas that often interfere with reading. The associated classic retinal toxicity is described as a bull’s eye maculopathy (ring of depigmented retinal pigment epithelium that spares the foveal area). Hydroxychloroquine bull's eye maculopathy guidelines Hydroxychloroquine Plaquenil Toxicity and Recommendations., Retinal Physician - Hydroxychloroquine Maculopathy An Update. While taking plaquenil what foods to avoidChloroquine and parkinson's diseaseAtp quantification assay chloroquinePlaquenil liver failure Mar 02, 2018 The new guideline on screening for hydroxychloroquine and chloroquine retinopathy is written in response to evidence from the United States that shows that hydroxychloroquine retinopathy is more common than previously recognised. Implementation of the guideline’s recommendations will prevent iatrogenic visual loss. RCOphth guideline Hydroxychloroquine and Chloroquine.. Hydroxychloroquine Retinopathy Application of the 2011.. Early Plaquenil Toxicity Detected without Bull’s Eye Maculopathy. The retina is generally flat in the other conditions associated with bull's-eye maculopathy, and the elevated cuff of subretinal fluid around a macular hole is a key finding in distinguishing a macular hole from other entities in the differential diagnosis of bull's-eye maculopathy. Advanced retinal toxicity is seen by the clinician as a bull's-eye maculopathy, presenting as concentric rings of hyperpigmentation and hypopigmentation, or possibly as an extramacular pattern of. The patient was again dilated with 1% tropicamide and 2.5% phenylephrine. Vitreous and optic nerve were normal. Macula showed very slight bulls-eye macular changes. FA showed subtle bulls-eye maculopathy, and the repeated OCT showed slight parafoveal OCT ellipsoid zone EZ loss consistent with Plaquenil toxicity.