Drusen - Basal Laminar Drusen - 19 Year Old with Lupus Nephritis
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19-year-old was seen in the office on May 5, 2009. She has a history of developing severe systemic lupus erythematosus in 2001. She was in renal failure and had biopsy proven Class 2 lupus nephritis. She is currently on Plaquenil 400 mg for six years, as well as Prednisolone orally, every other day. She is having some difficulty reading in her current progressive glasses. You saw a problem with her macula and suggest that she come in here for an evaluation.
VISUAL ACUITY: OD 20/20, OS 20/25. IOP: OD 8, OS 11. Amsler grid was normal in both eyes. Color vision was normal in both eyes.
SLIT EXAMINATION: Normal with clear lens.
EXTENDED OPHTHALMOSCOPY:
OD: Vertical C/D ratio is 0.2. There is no posterior vitreous separation and 2+ multiple macular drusen. There is no bull’s-eye maculopathy.
OS: Vertical C/D ratio is 0.2. There is no posterior vitreous separation, again there are 2+ multifocal small cuticular macular drusen.
OCT SCAN: The OCT scans were normal. Photos confirm clinical findings.
FLUORESCEIN ANGIOGRAPHY: Fluorescein angiography shows early hyperfluorescence of tiny macular drusen scattered throughout the macula in both eyes.
IMPRESSION:
1. BASAL LAMINAR (CUTICULAR) DRUSEN – BOTH EYES
2. NO PLAQUENIL TOXICITY
DISCUSSION: I explained to the family that she does have macular drusen in both eyes, which are sometimes associated with Type 2 membrane proliferative glomerular nephritis, but not with Class 2 lupus nephritis. Still, it is suspicious that she has a severe kidney disease and has these macular drusen. Hopefully these will not be progressive. Some people with basal laminar drusen do lose some central vision in their fifty’s and sixty’s. I asked her to return for a check in one year or sooner should she notice a problem and to see you back regularly. Again, I see no sign of Plaquenil toxicity, but she does need to be watched for that.
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Basal Laminar Drusen - Cuticular Drusen - 19 Year Old with Lupus Nephritisvaatamisi: 64819-year-old. She has a history of developing severe systemic lupus erythematosus in 2001. She was in renal failure and had biopsy proven Class 2 lupus nephritis. She is currently on Plaquenil 400 mg for six years, as well as Prednisolone orally, every other day. OD 20/20, OS 20/25.
(0 hinnangut)
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Basal Laminar Drusen - Cuticular Drusen - 19 Year Old with Lupus Nephritisvaatamisi: 47019-year-old. She has a history of developing severe systemic lupus erythematosus in 2001. She was in renal failure and had biopsy proven Class 2 lupus nephritis. She is currently on Plaquenil 400 mg for six years, as well as Prednisolone orally, every other day. OD 20/20, OS 20/25.
(0 hinnangut)
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Basal Laminar Drusen - Cuticular Drusen - 19 Year Old with Lupus Nephritisvaatamisi: 50219-year-old. She has a history of developing severe systemic lupus erythematosus in 2001. She was in renal failure and had biopsy proven Class 2 lupus nephritis. She is currently on Plaquenil 400 mg for six years, as well as Prednisolone orally, every other day. OD 20/20, OS 20/25.
(0 hinnangut)
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Basal Laminar Drusen - Cuticular Drusen - 19 Year Old with Lupus Nephritisvaatamisi: 52719-year-old. She has a history of developing severe systemic lupus erythematosus in 2001. She was in renal failure and had biopsy proven Class 2 lupus nephritis. She is currently on Plaquenil 400 mg for six years, as well as Prednisolone orally, every other day. OD 20/20, OS 20/25.
(0 hinnangut)
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Basal Laminar Drusen - Cuticular Drusen - 19 Year Old with Lupus Nephritisvaatamisi: 55519-year-old. She has a history of developing severe systemic lupus erythematosus in 2001. She was in renal failure and had biopsy proven Class 2 lupus nephritis. She is currently on Plaquenil 400 mg for six years, as well as Prednisolone orally, every other day. OD 20/20, OS 20/25.
(0 hinnangut)
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|
Basal Laminar Drusen - Cuticular Drusen - 19 Year Old with Lupus Nephritisvaatamisi: 56219-year-old. She has a history of developing severe systemic lupus erythematosus in 2001. She was in renal failure and had biopsy proven Class 2 lupus nephritis. She is currently on Plaquenil 400 mg for six years, as well as Prednisolone orally, every other day. OD 20/20, OS 20/25.
(0 hinnangut)
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|
Basal Laminar Drusen - Cuticular Drusen - 19 Year Old with Lupus Nephritisvaatamisi: 55119-year-old. She has a history of developing severe systemic lupus erythematosus in 2001. She was in renal failure and had biopsy proven Class 2 lupus nephritis. She is currently on Plaquenil 400 mg for six years, as well as Prednisolone orally, every other day. OD 20/20, OS 20/25.
(0 hinnangut)
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Basal Laminar Drusen - Cuticular Drusen - 19 Year Old with Lupus Nephritisvaatamisi: 121319-year-old. She has a history of developing severe systemic lupus erythematosus in 2001. She was in renal failure and had biopsy proven Class 2 lupus nephritis. She is currently on Plaquenil 400 mg for six years, as well as Prednisolone orally, every other day. OD 20/20, OS 20/25.
(0 hinnangut)
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Basal Laminar Drusen - Cuticular Drusen - 19 Year Old with Lupus Nephritisvaatamisi: 66019-year-old. She has a history of developing severe systemic lupus erythematosus in 2001. She was in renal failure and had biopsy proven Class 2 lupus nephritis. She is currently on Plaquenil 400 mg for six years, as well as Prednisolone orally, every other day. OD 20/20, OS 20/25.
(0 hinnangut)
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|
Basal Laminar Drusen - Cuticular Drusen - 19 Year Old with Lupus Nephritisvaatamisi: 73319-year-old. She has a history of developing severe systemic lupus erythematosus in 2001. She was in renal failure and had biopsy proven Class 2 lupus nephritis. She is currently on Plaquenil 400 mg for six years, as well as Prednisolone orally, every other day. OD 20/20, OS 20/25.
(0 hinnangut)
|
|
Basal Laminar Drusen - Cuticular Drusen - 19 Year Old with Lupus Nephritisvaatamisi: 64319-year-old. She has a history of developing severe systemic lupus erythematosus in 2001. She was in renal failure and had biopsy proven Class 2 lupus nephritis. She is currently on Plaquenil 400 mg for six years, as well as Prednisolone orally, every other day. OD 20/20, OS 20/25.
(0 hinnangut)
|
|
Basal Laminar Drusen - Cuticular Drusen - 19 Year Old with Lupus Nephritisvaatamisi: 62919-year-old. She has a history of developing severe systemic lupus erythematosus in 2001. She was in renal failure and had biopsy proven Class 2 lupus nephritis. She is currently on Plaquenil 400 mg for six years, as well as Prednisolone orally, every other day. OD 20/20, OS 20/25.
(0 hinnangut)
|
|
Basal Laminar Drusen - Cuticular Drusen - 19 Year Old with Lupus Nephritisvaatamisi: 60419-year-old. She has a history of developing severe systemic lupus erythematosus in 2001. She was in renal failure and had biopsy proven Class 2 lupus nephritis. She is currently on Plaquenil 400 mg for six years, as well as Prednisolone orally, every other day. OD 20/20, OS 20/25.
(0 hinnangut)
|
|
Basal Laminar Drusen - Cuticular Drusen - 19 Year Old with Lupus Nephritisvaatamisi: 59419-year-old. She has a history of developing severe systemic lupus erythematosus in 2001. She was in renal failure and had biopsy proven Class 2 lupus nephritis. She is currently on Plaquenil 400 mg for six years, as well as Prednisolone orally, every other day. OD 20/20, OS 20/25.
(0 hinnangut)
|
|
Basal Laminar Drusen - Cuticular Drusen - 19 Year Old with Lupus Nephritisvaatamisi: 60319-year-old. She has a history of developing severe systemic lupus erythematosus in 2001. She was in renal failure and had biopsy proven Class 2 lupus nephritis. She is currently on Plaquenil 400 mg for six years, as well as Prednisolone orally, every other day. OD 20/20, OS 20/25.
(0 hinnangut)
|
|
Basal Laminar Drusen - Cuticular Drusen - 19 Year Old with Lupus Nephritisvaatamisi: 64719-year-old. She has a history of developing severe systemic lupus erythematosus in 2001. She was in renal failure and had biopsy proven Class 2 lupus nephritis. She is currently on Plaquenil 400 mg for six years, as well as Prednisolone orally, every other day. OD 20/20, OS 20/25.
(0 hinnangut)
|
|
Basal Laminar Drusen - Cuticular Drusen - 19 Year Old with Lupus Nephritisvaatamisi: 52719-year-old. She has a history of developing severe systemic lupus erythematosus in 2001. She was in renal failure and had biopsy proven Class 2 lupus nephritis. She is currently on Plaquenil 400 mg for six years, as well as Prednisolone orally, every other day. OD 20/20, OS 20/25.
(0 hinnangut)
|
|
Basal Laminar Drusen - Cuticular Drusen - 19 Year Old with Lupus Nephritisvaatamisi: 53919-year-old. She has a history of developing severe systemic lupus erythematosus in 2001. She was in renal failure and had biopsy proven Class 2 lupus nephritis. She is currently on Plaquenil 400 mg for six years, as well as Prednisolone orally, every other day. OD 20/20, OS 20/25.
(0 hinnangut)
|
|
Basal Laminar Drusen - Cuticular Drusen - 19 Year Old with Lupus Nephritisvaatamisi: 57219-year-old. She has a history of developing severe systemic lupus erythematosus in 2001. She was in renal failure and had biopsy proven Class 2 lupus nephritis. She is currently on Plaquenil 400 mg for six years, as well as Prednisolone orally, every other day. OD 20/20, OS 20/25.
(0 hinnangut)
|
|
Basal Laminar Drusen - Cuticular Drusen - 19 Year Old with Lupus Nephritisvaatamisi: 57619-year-old. She has a history of developing severe systemic lupus erythematosus in 2001. She was in renal failure and had biopsy proven Class 2 lupus nephritis. She is currently on Plaquenil 400 mg for six years, as well as Prednisolone orally, every other day. OD 20/20, OS 20/25.
(0 hinnangut)
|
|
Basal Laminar Drusen - Cuticular Drusen - 19 Year Old with Lupus Nephritisvaatamisi: 62719-year-old. She has a history of developing severe systemic lupus erythematosus in 2001. She was in renal failure and had biopsy proven Class 2 lupus nephritis. She is currently on Plaquenil 400 mg for six years, as well as Prednisolone orally, every other day. OD 20/20, OS 20/25.
(0 hinnangut)
|
|
Basal Laminar Drusen - Cuticular Drusen - 19 Year Old with Lupus Nephritisvaatamisi: 63119-year-old. She has a history of developing severe systemic lupus erythematosus in 2001. She was in renal failure and had biopsy proven Class 2 lupus nephritis. She is currently on Plaquenil 400 mg for six years, as well as Prednisolone orally, every other day. OD 20/20, OS 20/25.
(0 hinnangut)
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19-year-old was seen in the office on May 5, 2009. She has a history of developing severe systemic lupus erythematosus in 2001. She was in renal failure and had biopsy proven Class 2 lupus nephritis. She is currently on Plaquenil 400 mg for six years, as well as Prednisolone orally, every other day. She is having some difficulty reading in her current progressive glasses. You saw a problem with her macula and suggest that she come in here for an evaluation.
VISUAL ACUITY: OD 20/20, OS 20/25. IOP: OD 8, OS 11. Amsler grid was normal in both eyes. Color vision was normal in both eyes.
SLIT EXAMINATION: Normal with clear lens.
EXTENDED OPHTHALMOSCOPY:
OD: Vertical C/D ratio is 0.2. There is no posterior vitreous separation and 2+ multiple macular drusen. There is no bull’s-eye maculopathy.
OS: Vertical C/D ratio is 0.2. There is no posterior vitreous separation, again there are 2+ multifocal small cuticular macular drusen.
OCT SCAN: The OCT scans were normal. Photos confirm clinical findings.
FLUORESCEIN ANGIOGRAPHY: Fluorescein angiography shows early hyperfluorescence of tiny macular drusen scattered throughout the macula in both eyes.
IMPRESSION:
1. BASAL LAMINAR (CUTICULAR) DRUSEN – BOTH EYES
2. NO PLAQUENIL TOXICITY
DISCUSSION: I explained to the family that she does have macular drusen in both eyes, which are sometimes associated with Type 2 membrane proliferative glomerular nephritis, but not with Class 2 lupus nephritis. Still, it is suspicious that she has a severe kidney disease and has these macular drusen. Hopefully these will not be progressive. Some people with basal laminar drusen do lose some central vision in their fifty’s and sixty’s. I asked her to return for a check in one year or sooner should she notice a problem and to see you back regularly. Again, I see no sign of Plaquenil toxicity, but she does need to be watched for that.
