Plaquenil Toxicity - Bull's Eye Maculopathy - 25 Years Therapy
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73-year-old woman has been on Plaquenil she thinks probably for about the last twenty to twenty five years. She was diagnosed at that time with arthritis. Her sister has severe arthritis. She was tested and the tests showed not only that she was positive, but also she had very high sedimentation rates. She has been on treatment since then and fortunately she has not had any joint problems. You were concerned though because of a visual field issue, about possible Plaquenil toxicity. She also had a lung surgery in 2004 and not a sarcoma. She had breast surgery in 2005 for breast cancer, but currently she is free of any cancer. For her arthritis she is diagnosed as a possible crossover between lupus and rheumatoid arthritis and she has also fibromyalgia.
VISUAL ACUITY: OD 20/70, OS 20/30. IOP: OD 15, OS 16. Her color vision was 0 out 10 correct in both eyes and she also missed the controls. She has a posterior chamber intraocular lens in good position in both eyes.
EXTENDED OPHTHALMOSCOPY:
OD: Vertical C/D ratio is 0.2. There is posterior vitreous separation. There is an area of atrophy that is concentric atrophy.
OS: Vertical C/D ratio is 0.2. There is posterior vitreous separation with concentric geographic atrophy.
OCT SCAN: The OCT scan shows retinal atrophy in both eyes. The average central foveal thickness in the right eye is 170 microns with a volume of 4.85 mm3. The left eye has 161 microns with a volume of 5.18 mm3. The line scans show loss of the photoreceptor integrity around the macula in both eyes. Photos confirm clinical findings.
FLUORESCEIN ANGIOGRAPHY: Fluorescein angiography shows a classic bull’s eye maculopathy in each eye from the Plaquenil toxicity.
IMPRESSION:
1. PLAQUENIL TOXICITY – BOTH EYES WITH BULLS EYE MACULOPATHY
DISCUSSION: I explained to the patient she has unfortunately Plaquenil toxicity. I told her to stop the drug and to talk to her doctors. I asked her to return for a check in six months or sooner if she should notice a problem.
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Plaquenil (Hydroxycholorquine) Toxicity - Bull's Eye Maculopathy - 73 year old womand 25 Years therapy - 64 inches tall - 110 lbsvu 673 fois73-year-old woman has been on Plaquenil for twenty five years. She noticed loss of paracentral vision a few months ago. VISUAL ACUITY: OD 20/70, OS 20/30. Her color vision was 0 out 10 correct in both eyes and she also missed the controls. 
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Plaquenil (Hydroxycholorquine) Toxicity - Bull's Eye Maculopathy - 73 year old womand 25 Years therapy - 64 inches tall - 110 lbsvu 839 fois73-year-old woman has been on Plaquenil for twenty five years. She noticed loss of paracentral vision a few months ago. VISUAL ACUITY: OD 20/70, OS 20/30. Her color vision was 0 out 10 correct in both eyes and she also missed the controls.
(0 votes)
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Plaquenil (Hydroxycholorquine) Toxicity - Bull's Eye Maculopathy - 73 year old womand 25 Years therapy - 64 inches tall - 110 lbsvu 582 fois73-year-old woman has been on Plaquenil for twenty five years. She noticed loss of paracentral vision a few months ago. VISUAL ACUITY: OD 20/70, OS 20/30. Her color vision was 0 out 10 correct in both eyes and she also missed the controls.
(0 votes)
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Plaquenil (Hydroxycholorquine) Toxicity - Bull's Eye Maculopathy - 73 year old womand 25 Years therapy - 64 inches tall - 110 lbsvu 829 fois73-year-old woman has been on Plaquenil for twenty five years. She noticed loss of paracentral vision a few months ago. VISUAL ACUITY: OD 20/70, OS 20/30. Her color vision was 0 out 10 correct in both eyes and she also missed the controls.
(0 votes)
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Plaquenil (Hydroxycholorquine) Toxicity - Bull's Eye Maculopathy - 73 year old womand 25 Years therapy - 64 inches tall - 110 lbsvu 880 fois73-year-old woman has been on Plaquenil for twenty five years. She noticed loss of paracentral vision a few months ago. VISUAL ACUITY: OD 20/70, OS 20/30. Her color vision was 0 out 10 correct in both eyes and she also missed the controls.
(0 votes)
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Plaquenil (Hydroxycholorquine) Toxicity - Bull's Eye Maculopathy - 73 year old womand 25 Years therapy - 64 inches tall - 110 lbsvu 787 fois73-year-old woman has been on Plaquenil for twenty five years. She noticed loss of paracentral vision a few months ago. VISUAL ACUITY: OD 20/70, OS 20/30. Her color vision was 0 out 10 correct in both eyes and she also missed the controls.
(0 votes)
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Plaquenil (Hydroxycholorquine) Toxicity - Bull's Eye Maculopathy - 73 year old womand 25 Years therapy - 64 inches tall - 110 lbsvu 514 fois73-year-old woman has been on Plaquenil for twenty five years. She noticed loss of paracentral vision a few months ago. VISUAL ACUITY: OD 20/70, OS 20/30. Her color vision was 0 out 10 correct in both eyes and she also missed the controls.
(0 votes)
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Plaquenil (Hydroxycholorquine) Toxicity - Bull's Eye Maculopathy - 73 year old womand 25 Years therapy - 64 inches tall - 110 lbsvu 503 fois73-year-old woman has been on Plaquenil for twenty five years. She noticed loss of paracentral vision a few months ago. VISUAL ACUITY: OD 20/70, OS 20/30. Her color vision was 0 out 10 correct in both eyes and she also missed the controls.
(0 votes)
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Plaquenil (Hydroxycholorquine) Toxicity - Bull's Eye Maculopathy - 73 year old womand 25 Years therapy - 64 inches tall - 110 lbsvu 593 fois73-year-old woman has been on Plaquenil for twenty five years. She noticed loss of paracentral vision a few months ago. VISUAL ACUITY: OD 20/70, OS 20/30. Her color vision was 0 out 10 correct in both eyes and she also missed the controls.
(0 votes)
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Plaquenil (Hydroxycholorquine) Toxicity - Bull's Eye Maculopathy - 73 year old womand 25 Years therapy - 64 inches tall - 110 lbsvu 718 fois73-year-old woman has been on Plaquenil for twenty five years. She noticed loss of paracentral vision a few months ago. VISUAL ACUITY: OD 20/70, OS 20/30. Her color vision was 0 out 10 correct in both eyes and she also missed the controls.
(0 votes)
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Plaquenil (Hydroxycholorquine) Toxicity - Bull's Eye Maculopathy - 73 year old womand 25 Years therapy - 64 inches tall - 110 lbsvu 627 fois73-year-old woman has been on Plaquenil for twenty five years. She noticed loss of paracentral vision a few months ago. VISUAL ACUITY: OD 20/70, OS 20/30. Her color vision was 0 out 10 correct in both eyes and she also missed the controls.
(0 votes)
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Plaquenil (Hydroxycholorquine) Toxicity - Bull's Eye Maculopathy - 73 year old womand 25 Years therapy - 64 inches tall - 110 lbsvu 547 fois73-year-old woman has been on Plaquenil for twenty five years. She noticed loss of paracentral vision a few months ago. VISUAL ACUITY: OD 20/70, OS 20/30. Her color vision was 0 out 10 correct in both eyes and she also missed the controls.
(0 votes)
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Plaquenil (Hydroxycholorquine) Toxicity - Bull's Eye Maculopathy - 73 year old womand 25 Years therapy - 64 inches tall - 110 lbsvu 545 fois73-year-old woman has been on Plaquenil for twenty five years. She noticed loss of paracentral vision a few months ago. VISUAL ACUITY: OD 20/70, OS 20/30. Her color vision was 0 out 10 correct in both eyes and she also missed the controls.
(0 votes)
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Plaquenil (Hydroxycholorquine) Toxicity - Bull's Eye Maculopathy - 73 year old womand 25 Years therapy - 64 inches tall - 110 lbsvu 587 fois73-year-old woman has been on Plaquenil for twenty five years. She noticed loss of paracentral vision a few months ago. VISUAL ACUITY: OD 20/70, OS 20/30. Her color vision was 0 out 10 correct in both eyes and she also missed the controls.
(0 votes)
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Plaquenil (Hydroxycholorquine) Toxicity - Bull's Eye Maculopathy - 73 year old womand 25 Years therapy - 64 inches tall - 110 lbsvu 453 fois73-year-old woman has been on Plaquenil for twenty five years. She noticed loss of paracentral vision a few months ago. VISUAL ACUITY: OD 20/70, OS 20/30. Her color vision was 0 out 10 correct in both eyes and she also missed the controls.
(0 votes)
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Plaquenil (Hydroxycholorquine) Toxicity - Bull's Eye Maculopathy - 73 year old womand 25 Years therapy - 64 inches tall - 110 lbsvu 443 fois73-year-old woman has been on Plaquenil for twenty five years. She noticed loss of paracentral vision a few months ago. VISUAL ACUITY: OD 20/70, OS 20/30. Her color vision was 0 out 10 correct in both eyes and she also missed the controls.
(0 votes)
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Plaquenil (Hydroxycholorquine) Toxicity - Bull's Eye Maculopathy - 73 year old womand 25 Years therapy - 64 inches tall - 110 lbsvu 451 fois73-year-old woman has been on Plaquenil for twenty five years. She noticed loss of paracentral vision a few months ago. VISUAL ACUITY: OD 20/70, OS 20/30. Her color vision was 0 out 10 correct in both eyes and she also missed the controls.
(0 votes)
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Plaquenil (Hydroxycholorquine) Toxicity - Bull's Eye Maculopathy - 73 year old womand 25 Years therapy - 64 inches tall - 110 lbsvu 456 fois73-year-old woman has been on Plaquenil for twenty five years. She noticed loss of paracentral vision a few months ago. VISUAL ACUITY: OD 20/70, OS 20/30. Her color vision was 0 out 10 correct in both eyes and she also missed the controls.
(0 votes)
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Plaquenil (Hydroxycholorquine) Toxicity - Bull's Eye Maculopathy - 73 year old womand 25 Years therapy - 64 inches tall - 110 lbsvu 495 fois73-year-old woman has been on Plaquenil for twenty five years. She noticed loss of paracentral vision a few months ago. VISUAL ACUITY: OD 20/70, OS 20/30. Her color vision was 0 out 10 correct in both eyes and she also missed the controls.
(0 votes)
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Plaquenil (Hydroxycholorquine) Toxicity - Bull's Eye Maculopathy - 73 year old womand 25 Years therapy - 64 inches tall - 110 lbsvu 452 fois73-year-old woman has been on Plaquenil for twenty five years. She noticed loss of paracentral vision a few months ago. VISUAL ACUITY: OD 20/70, OS 20/30. Her color vision was 0 out 10 correct in both eyes and she also missed the controls.
(0 votes)
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Plaquenil (Hydroxycholorquine) Toxicity - Bull's Eye Maculopathy - 73 year old womand 25 Years therapy - 64 inches tall - 110 lbsvu 450 fois73-year-old woman has been on Plaquenil for twenty five years. She noticed loss of paracentral vision a few months ago. VISUAL ACUITY: OD 20/70, OS 20/30. Her color vision was 0 out 10 correct in both eyes and she also missed the controls.
(0 votes)
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Plaquenil (Hydroxycholorquine) Toxicity - Bull's Eye Maculopathy - 73 year old womand 25 Years therapy - 64 inches tall - 110 lbsvu 545 fois73-year-old woman has been on Plaquenil for twenty five years. She noticed loss of paracentral vision a few months ago. VISUAL ACUITY: OD 20/70, OS 20/30. Her color vision was 0 out 10 correct in both eyes and she also missed the controls.
(0 votes)
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Plaquenil (Hydroxycholorquine) Toxicity - Bull's Eye Maculopathy - 73 year old womand 25 Years therapy - 64 inches tall - 110 lbsvu 473 fois73-year-old woman has been on Plaquenil for twenty five years. She noticed loss of paracentral vision a few months ago. VISUAL ACUITY: OD 20/70, OS 20/30. Her color vision was 0 out 10 correct in both eyes and she also missed the controls.
(0 votes)
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Plaquenil (Hydroxycholorquine) Toxicity - Bull's Eye Maculopathy - 73 year old womand 25 Years therapy - 64 inches tall - 110 lbsvu 461 fois73-year-old woman has been on Plaquenil for twenty five years. She noticed loss of paracentral vision a few months ago. VISUAL ACUITY: OD 20/70, OS 20/30. Her color vision was 0 out 10 correct in both eyes and she also missed the controls.
(0 votes)
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Plaquenil (Hydroxycholorquine) Toxicity - Bull's Eye Maculopathy - 73 year old womand 25 Years therapy - 64 inches tall - 110 lbsvu 631 fois73-year-old woman has been on Plaquenil for twenty five years. She noticed loss of paracentral vision a few months ago. VISUAL ACUITY: OD 20/70, OS 20/30. Her color vision was 0 out 10 correct in both eyes and she also missed the controls.
(0 votes)
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Plaquenil Toxicity - Bull's Eye Maculopathy - 25 Years Therapy - Fundus Autofluorescencevu 702 fois73-year-old woman has been on Plaquenil for twenty five years. Plaquenil has now been stopped for 6 months. VA continues to decline as does visual function - 20/80 OD , 20/40 OS
(1 votes)
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Plaquenil Toxicity - Bull's Eye Maculopathy - 25 Years Therapy - InfraRed Imagevu 495 fois73-year-old woman has been on Plaquenil for twenty five years. Plaquenil has now been stopped for 6 months. VA continues to decline as does visual function - 20/80 OD , 20/40 OS
(0 votes)
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Plaquenil Toxicity - Bull's Eye Maculopathy - 25 Years Therapy - OCT Line Scanvu 789 fois73-year-old woman has been on Plaquenil for twenty five years. Plaquenil has now been stopped for 6 months. VA continues to decline as does visual function - 20/80 OD , 20/40 OS
(1 votes)
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Plaquenil Toxicity - Bull's Eye Maculopathy - 25 Years Therapy - OCT Video - TAKES TIME TO LOADvu 643 fois73-year-old woman has been on Plaquenil for twenty five years. Plaquenil has now been stopped for 6 months. VA continues to decline as does visual function - 20/80 OD , 20/40 OS
(0 votes)
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Plaquenil Toxicity - Bull's Eye Maculopathy - 25 Years Therapy OCT Posterior Pole MAPvu 544 fois73-year-old woman has been on Plaquenil for twenty five years. Plaquenil has now been stopped for 6 months. VA continues to decline as does visual function - 20/80 OD , 20/40 OS
(0 votes)
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Plaquenil Toxicity - Bull's Eye Maculopathy - 25 Years Therapy - Fundus Autofluorescencevu 1178 fois73-year-old woman has been on Plaquenil for twenty five years. Plaquenil has now been stopped for 6 months. VA continues to decline as does visual function - 20/80 OD , 20/40 OS
(1 votes)
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Plaquenil Toxicity - Bull's Eye Maculopathy - 25 Years Therapy - Infra-red Imagevu 604 fois73-year-old woman has been on Plaquenil for twenty five years. Plaquenil has now been stopped for 6 months. VA continues to decline as does visual function - 20/80 OD , 20/40 OS
(0 votes)
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Plaquenil Toxicity - Bull's Eye Maculopathy - 25 Years Therapy OCT Line Scanvu 974 fois73-year-old woman has been on Plaquenil for twenty five years. Plaquenil has now been stopped for 6 months. VA continues to decline as does visual function - 20/80 OD , 20/40 OS
(0 votes)
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Plaquenil Toxicity - Bull's Eye Maculopathy - 25 Years Therapy - OCT Posterior Pole MAPvu 625 fois73-year-old woman has been on Plaquenil for twenty five years. Plaquenil has now been stopped for 6 months. VA continues to decline as does visual function - 20/80 OD , 20/40 OS
(0 votes)
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Plaquenil Toxicity - Bull's Eye Maculopathy - 25 Years Therapy - OCT Video - TAKES TIME TO LOADvu 827 fois73-year-old woman has been on Plaquenil for twenty five years. Plaquenil has now been stopped for 6 months. VA continues to decline as does visual function - 20/80 OD , 20/40 OS
(0 votes)
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73-year-old woman has been on Plaquenil she thinks probably for about the last twenty to twenty five years. She was diagnosed at that time with arthritis. Her sister has severe arthritis. She was tested and the tests showed not only that she was positive, but also she had very high sedimentation rates. She has been on treatment since then and fortunately she has not had any joint problems. You were concerned though because of a visual field issue, about possible Plaquenil toxicity. She also had a lung surgery in 2004 and not a sarcoma. She had breast surgery in 2005 for breast cancer, but currently she is free of any cancer. For her arthritis she is diagnosed as a possible crossover between lupus and rheumatoid arthritis and she has also fibromyalgia.
VISUAL ACUITY: OD 20/70, OS 20/30. IOP: OD 15, OS 16. Her color vision was 0 out 10 correct in both eyes and she also missed the controls. She has a posterior chamber intraocular lens in good position in both eyes.
EXTENDED OPHTHALMOSCOPY:
OD: Vertical C/D ratio is 0.2. There is posterior vitreous separation. There is an area of atrophy that is concentric atrophy.
OS: Vertical C/D ratio is 0.2. There is posterior vitreous separation with concentric geographic atrophy.
OCT SCAN: The OCT scan shows retinal atrophy in both eyes. The average central foveal thickness in the right eye is 170 microns with a volume of 4.85 mm3. The left eye has 161 microns with a volume of 5.18 mm3. The line scans show loss of the photoreceptor integrity around the macula in both eyes. Photos confirm clinical findings.
FLUORESCEIN ANGIOGRAPHY: Fluorescein angiography shows a classic bull’s eye maculopathy in each eye from the Plaquenil toxicity.
IMPRESSION:
1. PLAQUENIL TOXICITY – BOTH EYES WITH BULLS EYE MACULOPATHY
DISCUSSION: I explained to the patient she has unfortunately Plaquenil toxicity. I told her to stop the drug and to talk to her doctors. I asked her to return for a check in six months or sooner if she should notice a problem.
