TY - JOUR
T1 - Retinal toxicity secondary to Plaquenil therapy
AU - Hanna, Betty
AU - Holdeman, Nicky R.
AU - Tang, Rosa A.
AU - Schiffman, Jade S.
N1 - Copyright:
Copyright 2008 Elsevier B.V., All rights reserved.
PY - 2008/2
Y1 - 2008/2
N2 - Background: Hydroxychloroquine sulfate (Plaquenil; Sanofi-Aventis, Bridgewater, New Jersey) is an antimalarial agent, which is sometimes used for the treatment of certain autoimmune disorders. Its use has been associated with ocular side effects; the most concerning is toxic maculopathy. Case report: A 71-year-old arthritic white woman requested a second opinion regarding retinal Plaquenil toxicity. The patient°Fs history was significant for seronegative rheumatoid arthritis diagnosed 6 years prior. She had taken Plaquenil 400 mg a day for about 5 years but had discontinued the drug 6 months before when bilateral central scotomas were first noted. At the consultation visit, her visual acuities were 20/20 in both eyes. SITA-Standard 10-2 disclosed a dense scotoma with 4° of central sparing in each eye. Fundus examination found retinal pigment epithelium changes bilaterally; no "bull°Fs eye" retinopathy was observed. Conclusion: Withdrawal of the medication is the only effective treatment for Plaquenil toxicity and, even then, the toxic effects may progress because of the slow clearance of the drug. Though controversy exists regarding screening recommendations, a baseline ophthalmic examination should be performed on all patients before initiating Plaquenil. If a patient is considered low risk, examinations can be scheduled annually. For high-risk patients, 6-month progress visits are strongly recommended.
AB - Background: Hydroxychloroquine sulfate (Plaquenil; Sanofi-Aventis, Bridgewater, New Jersey) is an antimalarial agent, which is sometimes used for the treatment of certain autoimmune disorders. Its use has been associated with ocular side effects; the most concerning is toxic maculopathy. Case report: A 71-year-old arthritic white woman requested a second opinion regarding retinal Plaquenil toxicity. The patient°Fs history was significant for seronegative rheumatoid arthritis diagnosed 6 years prior. She had taken Plaquenil 400 mg a day for about 5 years but had discontinued the drug 6 months before when bilateral central scotomas were first noted. At the consultation visit, her visual acuities were 20/20 in both eyes. SITA-Standard 10-2 disclosed a dense scotoma with 4° of central sparing in each eye. Fundus examination found retinal pigment epithelium changes bilaterally; no "bull°Fs eye" retinopathy was observed. Conclusion: Withdrawal of the medication is the only effective treatment for Plaquenil toxicity and, even then, the toxic effects may progress because of the slow clearance of the drug. Though controversy exists regarding screening recommendations, a baseline ophthalmic examination should be performed on all patients before initiating Plaquenil. If a patient is considered low risk, examinations can be scheduled annually. For high-risk patients, 6-month progress visits are strongly recommended.
KW - Bull°Fs eye maculopathy
KW - Fundus autofluorescence
KW - Hydroxychloroquine
KW - Multifocal electroretinogram
KW - Plaquenil toxicity
KW - Threshold Amsler grid
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U2 - 10.1016/j.optm.2007.08.017
DO - 10.1016/j.optm.2007.08.017
M3 - Article
C2 - 18215798
AN - SCOPUS:38349048548
SN - 1529-1839
VL - 79
SP - 90
EP - 94
JO - Optometry
JF - Optometry
IS - 2
ER -