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. Weight based dosing plaquenil Plaquenil slecht zien Abcc1 transporter chloroquine Apr 17, 2017 The classic lesion is described as a “bull’s eye” with relative hypo pigmentation surrounding a central area of hyper pigmentation, but this is a late finding and many time patients suffer from irreversible vision loss. The goal for Plaquenil Screening to detect toxicity early and stop the medication as soon as possible if present. Mechanism It is metabolized to oxalic acid which combines with calcium to form insoluble calcium oxalte salt. This is deposited in various body tissues & the RPE & inner retina in the eye. Ocular signs Fundus – numerous yellow-white punctate lesions in the posterior pole & periarterially. Clofazimine A 57-year-old female presented to the Ophthalmology clinic at UIHC complaining bilateral central photopsias for the past two years. She suffered from Sjogren syndrome and inflammatory arthritis and was currently treated with prednisone and methotrexate. She was previously treated with hydroxychloroquine Plaquenil 200mg bid 6.5mg/kg for 10 years, which was stopped one year prior to. 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). Chloroquine eye exam for macular lesions Common Medications That May Be Toxic to the Retina, Drug induced maculopathy - EyeWiki Plaquenil cause insomniaTreatment rheumatoid arthritis with methotrexate and hydroxychloroquinePlaquenil et maux de teteCan chloroquine injection terminate pregnancyHydroxychloroquine hair loss A dilated fundus exam revealed small cups with good rim coloration and perfusion O. U. There was a yellow-white elevated lesion in the macula of the right eye, seen here. The macula in the left eye showed mild changes in the retinal pigment epithelium, but we saw no fluid or subretinal hemorrhages. The peripheral retina was attached. Dilated Exam Spots Macular Lesion. Hydroxychloroquine Plaquenil Toxicity and.. Optical coherence tomography in a patient with chloroquine.. Fundus examination shows a subtle bull’s-eye macular lesion characterized by a central island of pigment surrounded by a depigmented zone of RPE atrophy, which itself is encircled by a hyperpigmented ring. The lesion may be more obvious on autofluorescence than on ophthalmoscopy. This stage can be missed before cataract surgery. She suffered from Sjogren syndrome and inflammatory arthritis and was currently treated with prednisone and methotrexate. She was previously treated with hydroxychloroquine Plaquenil 200mg bid 6.5mg/kg for 10 years, which was stopped one year prior to presentation. Of macular toxicity. All individuals starting these drugs should have a complete baseline 49 ophthalmologic examination within the first year of treatment including examination of the retina 50 with a dilated exam and visual fields by an automated threshold central visual field test 51 Humphrey 10-2.