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70-year-old woman in the office on March 28, 2008. She has been on Plaquenil for some time. She has systemic Lupus erythematosus and clotting problems. She was on the Plaquenil for about eight years and then off the Plaquenil for the last eight years because she developed macular toxicity. Although her vision was hazy, it was stable. She has noticed over the last several months substantially declining vision in her left eye. She finds it more difficult to read and get along, and especially trying to read the newspaper. She does have severe circulation and clotting problems, necessitating amputation of her left leg and her right foot, for which she is taking Coumadin. VISUAL ACUITY: OD 20/60, OS 20/100. IOP: OD 18, OS 19. SLIT LAMP EXAM: There is 2+ map-dot fingerprint corneal dystrophy in both eyes. The posterior chamber intraocular lens is in good position in both eyes. EXTENDED OPHTHALMOSCOPY: OD: Vertical C/D ratio is 0.6. There is peripapillary atrophy. There is a bull’s eye macular area of atrophy. There is no intraretinal or subretinal fluid. OS: Vertical C/D ratio is 0.6. There is peripapillary atrophy. There is also bull’s eye macular atrophy. There is no intraretinal or subretinal fluid. OCT SCAN: The OCT scan of the maculae shows severe foveal atrophy with the central foveal thickness in the right eye of 109 microns, the left eye 138 microns, both of which are well below normal and probably even less than the scan is showing because some of the lines are not accurate. NERVE FIBER LAYER SCAN: The nerve fiber layer scan shows nerve fiber layer atrophy in the left eye more than the right eye with the left eye having a 71 micron thickness on average and in the right eye 85 microns on average. Photos confirm clinical findings. FLUORESCEIN ANGIOGRAM: FA shows well-circumscribed hyperfluorescent circular lesions in both eyes, which do not change at all in the late frames. IMPRESSION: 1. BULLSEYE MACULOPATHY FROM PLAQUENIL TOXICITY – BOTH EYES 2. POSSIBLE CONCOMITANT DRY AGE-RELATED MACULAR DEGENERATION WITH PROGRESSING RETINAL ATROPHY 3. MAT-DOT FINGERPRINT CORNEAL DYSTROPHY – BOTH EYES 4. OPTIC PALLOR – MORE IN THE LEFT EYE THAN THE RIGHT EYE DISCUSSION: I explained to the patient that I do not see any active neovascular disease in either eye, but I am concerned about the vision change recently in the left eye. There are several things that maybe contributing. It may be that the macula is becoming more atrophic just with age-related changes on top of her previous Plaquenil toxicity. It may be that the cornea is an issue. She does have map-dot fingerprint corneal dystrophy. Finally, it may be the optic nerve is becoming more pale in response to circulation problems. I suggested she see you for a comprehensive evaluation and visual field testing. I asked her to take frequent Artificial Tears to see if that will help. I asked her to return here for a check next year.

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Plaquenil Toxicity - Bulls Eye Maculopathy549 views70-year-old woman with systemic Lupus erythematosus and clotting problems. She was on the Plaquenil for about eight years and then off the Plaquenil for the last eight years because she developed macular toxicity. Although her vision was hazy, it was stable. Recent deceased vision left eye: OD 20/60, OS 20/100. IOP: OD 18, OS 19.
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(0 votes)
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Plaquenil Toxicity - Bulls Eye Maculopathy845 views70-year-old woman with systemic Lupus erythematosus and clotting problems. She was on the Plaquenil for about eight years and then off the Plaquenil for the last eight years because she developed macular toxicity. Although her vision was hazy, it was stable. Recent deceased vision left eye: OD 20/60, OS 20/100. IOP: OD 18, OS 19.
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(0 votes)
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Plaquenil Toxicity - Bulls Eye Maculopathy495 views70-year-old woman with systemic Lupus erythematosus and clotting problems. She was on the Plaquenil for about eight years and then off the Plaquenil for the last eight years because she developed macular toxicity. Although her vision was hazy, it was stable. Recent deceased vision left eye: OD 20/60, OS 20/100. IOP: OD 18, OS 19.
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(0 votes)
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Plaquenil Toxicity - Bulls Eye Maculopathy489 views70-year-old woman with systemic Lupus erythematosus and clotting problems. She was on the Plaquenil for about eight years and then off the Plaquenil for the last eight years because she developed macular toxicity. Although her vision was hazy, it was stable. Recent deceased vision left eye: OD 20/60, OS 20/100. IOP: OD 18, OS 19.
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(0 votes)
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Plaquenil Toxicity - Bulls Eye Maculopathy490 views70-year-old woman with systemic Lupus erythematosus and clotting problems. She was on the Plaquenil for about eight years and then off the Plaquenil for the last eight years because she developed macular toxicity. Although her vision was hazy, it was stable. Recent deceased vision left eye: OD 20/60, OS 20/100. IOP: OD 18, OS 19.
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(0 votes)
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Plaquenil Toxicity - Bulls Eye Maculopathy272 views70-year-old woman with systemic Lupus erythematosus and clotting problems. She was on the Plaquenil for about eight years and then off the Plaquenil for the last eight years because she developed macular toxicity. Although her vision was hazy, it was stable. Recent deceased vision left eye: OD 20/60, OS 20/100. IOP: OD 18, OS 19.
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(0 votes)
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Plaquenil Toxicity - Bulls Eye Maculopathy195 views70-year-old woman with systemic Lupus erythematosus and clotting problems. She was on the Plaquenil for about eight years and then off the Plaquenil for the last eight years because she developed macular toxicity. Although her vision was hazy, it was stable. Recent deceased vision left eye: OD 20/60, OS 20/100. IOP: OD 18, OS 19.
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(0 votes)
plaquenilbullseyemac_camu_28729.png
Plaquenil Toxicity - Bulls Eye Maculopathy179 views70-year-old woman with systemic Lupus erythematosus and clotting problems. She was on the Plaquenil for about eight years and then off the Plaquenil for the last eight years because she developed macular toxicity. Although her vision was hazy, it was stable. Recent deceased vision left eye: OD 20/60, OS 20/100. IOP: OD 18, OS 19.
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(0 votes)
plaquenilbullseyemac_camu_28829.png
Plaquenil Toxicity - Bulls Eye Maculopathy158 views70-year-old woman with systemic Lupus erythematosus and clotting problems. She was on the Plaquenil for about eight years and then off the Plaquenil for the last eight years because she developed macular toxicity. Although her vision was hazy, it was stable. Recent deceased vision left eye: OD 20/60, OS 20/100. IOP: OD 18, OS 19.
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(0 votes)
plaquenilbullseyemac_camu_28929.png
Plaquenil Toxicity - Bulls Eye Maculopathy183 views70-year-old woman with systemic Lupus erythematosus and clotting problems. She was on the Plaquenil for about eight years and then off the Plaquenil for the last eight years because she developed macular toxicity. Although her vision was hazy, it was stable. Recent deceased vision left eye: OD 20/60, OS 20/100. IOP: OD 18, OS 19.
00000
(0 votes)
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Plaquenil Toxicity - Bulls Eye Maculopathy150 views70-year-old woman with systemic Lupus erythematosus and clotting problems. She was on the Plaquenil for about eight years and then off the Plaquenil for the last eight years because she developed macular toxicity. Although her vision was hazy, it was stable. Recent deceased vision left eye: OD 20/60, OS 20/100. IOP: OD 18, OS 19.
00000
(0 votes)
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Plaquenil Toxicity - Bulls Eye Maculopathy182 views70-year-old woman with systemic Lupus erythematosus and clotting problems. She was on the Plaquenil for about eight years and then off the Plaquenil for the last eight years because she developed macular toxicity. Although her vision was hazy, it was stable. Recent deceased vision left eye: OD 20/60, OS 20/100. IOP: OD 18, OS 19.
00000
(0 votes)
plaquenilbullseyemac_camu_281229.png
Plaquenil Toxicity - Bulls Eye Maculopathy157 views70-year-old woman with systemic Lupus erythematosus and clotting problems. She was on the Plaquenil for about eight years and then off the Plaquenil for the last eight years because she developed macular toxicity. Although her vision was hazy, it was stable. Recent deceased vision left eye: OD 20/60, OS 20/100. IOP: OD 18, OS 19.
00000
(0 votes)
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Plaquenil Toxicity - Bulls Eye Maculopathy153 views70-year-old woman with systemic Lupus erythematosus and clotting problems. She was on the Plaquenil for about eight years and then off the Plaquenil for the last eight years because she developed macular toxicity. Although her vision was hazy, it was stable. Recent deceased vision left eye: OD 20/60, OS 20/100. IOP: OD 18, OS 19.
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(0 votes)
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Plaquenil Toxicity - Bulls Eye Maculopathy298 views70-year-old woman with systemic Lupus erythematosus and clotting problems. She was on the Plaquenil for about eight years and then off the Plaquenil for the last eight years because she developed macular toxicity. Although her vision was hazy, it was stable. Recent deceased vision left eye: OD 20/60, OS 20/100. IOP: OD 18, OS 19.
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(0 votes)
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Plaquenil Toxicity - Bulls Eye Maculopathy140 views70-year-old woman with systemic Lupus erythematosus and clotting problems. She was on the Plaquenil for about eight years and then off the Plaquenil for the last eight years because she developed macular toxicity. Although her vision was hazy, it was stable. Recent deceased vision left eye: OD 20/60, OS 20/100. IOP: OD 18, OS 19.
00000
(0 votes)
plaquenilbullseyemac_camu_281629.png
Plaquenil Toxicity - Bulls Eye Maculopathy184 views70-year-old woman with systemic Lupus erythematosus and clotting problems. She was on the Plaquenil for about eight years and then off the Plaquenil for the last eight years because she developed macular toxicity. Although her vision was hazy, it was stable. Recent deceased vision left eye: OD 20/60, OS 20/100. IOP: OD 18, OS 19.
00000
(0 votes)
plaquenilbullseyemac_camu_281729.png
Plaquenil Toxicity - Bulls Eye Maculopathy188 views70-year-old woman with systemic Lupus erythematosus and clotting problems. She was on the Plaquenil for about eight years and then off the Plaquenil for the last eight years because she developed macular toxicity. Although her vision was hazy, it was stable. Recent deceased vision left eye: OD 20/60, OS 20/100. IOP: OD 18, OS 19.
00000
(0 votes)
plaquenilbullseyemac_camu_281829.png
Plaquenil Toxicity - Bulls Eye Maculopathy401 views70-year-old woman with systemic Lupus erythematosus and clotting problems. She was on the Plaquenil for about eight years and then off the Plaquenil for the last eight years because she developed macular toxicity. Although her vision was hazy, it was stable. Recent deceased vision left eye: OD 20/60, OS 20/100. IOP: OD 18, OS 19.
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(0 votes)
 
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70-year-old woman in the office on March 28, 2008. She has been on Plaquenil for some time. She has systemic Lupus erythematosus and clotting problems. She was on the Plaquenil for about eight years and then off the Plaquenil for the last eight years because she developed macular toxicity. Although her vision was hazy, it was stable. She has noticed over the last several months substantially declining vision in her left eye. She finds it more difficult to read and get along, and especially trying to read the newspaper. She does have severe circulation and clotting problems, necessitating amputation of her left leg and her right foot, for which she is taking Coumadin. VISUAL ACUITY: OD 20/60, OS 20/100. IOP: OD 18, OS 19. SLIT LAMP EXAM: There is 2+ map-dot fingerprint corneal dystrophy in both eyes. The posterior chamber intraocular lens is in good position in both eyes. EXTENDED OPHTHALMOSCOPY: OD: Vertical C/D ratio is 0.6. There is peripapillary atrophy. There is a bull’s eye macular area of atrophy. There is no intraretinal or subretinal fluid. OS: Vertical C/D ratio is 0.6. There is peripapillary atrophy. There is also bull’s eye macular atrophy. There is no intraretinal or subretinal fluid. OCT SCAN: The OCT scan of the maculae shows severe foveal atrophy with the central foveal thickness in the right eye of 109 microns, the left eye 138 microns, both of which are well below normal and probably even less than the scan is showing because some of the lines are not accurate. NERVE FIBER LAYER SCAN: The nerve fiber layer scan shows nerve fiber layer atrophy in the left eye more than the right eye with the left eye having a 71 micron thickness on average and in the right eye 85 microns on average. Photos confirm clinical findings. FLUORESCEIN ANGIOGRAM: FA shows well-circumscribed hyperfluorescent circular lesions in both eyes, which do not change at all in the late frames. IMPRESSION: 1. BULLSEYE MACULOPATHY FROM PLAQUENIL TOXICITY – BOTH EYES 2. POSSIBLE CONCOMITANT DRY AGE-RELATED MACULAR DEGENERATION WITH PROGRESSING RETINAL ATROPHY 3. MAT-DOT FINGERPRINT CORNEAL DYSTROPHY – BOTH EYES 4. OPTIC PALLOR – MORE IN THE LEFT EYE THAN THE RIGHT EYE DISCUSSION: I explained to the patient that I do not see any active neovascular disease in either eye, but I am concerned about the vision change recently in the left eye. There are several things that maybe contributing. It may be that the macula is becoming more atrophic just with age-related changes on top of her previous Plaquenil toxicity. It may be that the cornea is an issue. She does have map-dot fingerprint corneal dystrophy. Finally, it may be the optic nerve is becoming more pale in response to circulation problems. I suggested she see you for a comprehensive evaluation and visual field testing. I asked her to take frequent Artificial Tears to see if that will help. I asked her to return here for a check next year.