Last additions - Plaquenil Toxicity - Mild - Partial Bull's Eye Maculopathy 82-year-old woman was seen in the office on January 9, 2012. She was on Plaquenil from 1976 from 2005, 200 mg a day. It was discontinued because of abnormal visual fields. She is having more and more difficulty with glare. The glare she describes as being a problem is just instant. She has oncoming headlights. She has a lot of difficulty seeing or when the sun is in the eyes. It doesn’t sound like it is a light and dark adaptation, it sounds like she adapts pretty well. It is just while lights are in her eyes. She has cataracts, but she also has abnormal maculae and there is some concern about what if anything should be done for her.
VISUAL ACUITY: OD 20/32, OS 20/40. IOP: OD 14, OS 12.
SLIT EXAMINATION: There is 3+ nuclear sclerosis in both eyes.
EXTENDED OPHTHALMOSCOPY:
OD: Vertical C/D ratio is 0.0. There is posterior vitreous separation. There is a bull’s eye pigment irregularity in the macula.
OS: Vertical C/D ratio is 0.1. There is posterior vitreous separation. There is a mild bull’s eye pigment irregularity in the macula.
SPECTRALIS-SD-OCT SCAN: The OCT scan shows typical Plaquenil toxicity without retinal atrophy and a circle around the macula.
FUNDUS AUTO FLUORESCENCE: The fundus auto fluorescence confirms Plaquenil toxicity, worse in the left eye than the right eye with an area in the right eye of hyperfluorescence in the macula and the left eye there is an area of hypofluorescence in the macula. The images are slightly compromised by her cataracts.
IMPRESSION:
1. PLAQUENIL TOXICITY – BOTH EYES WITH BULL’S EYE MACULOPATHY
2. CATARACTS
DISCUSSION: I explained to the patient she does have Plaquenil toxicity with abnormal maculae. She also does have cataracts and I think given her description of her complaints, which are glare with oncoming headlights, there is an excellent chance that cataract surgery will alleviate her symptoms. I told her it is not a hundred percent of herpes, but she does have maculopathy, but probably there is a seventy or eighty percent chance she would have better visual function with the cataract surgery.
She is concerned about possibly getting worse and although it is possible, I think the risk of her getting worse and symptoms being worse with cataract surgery is probably no more than five or ten percent and I suggested she probably should seriously consider that.
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Plaquenil Toxicity both Eyes - Partial Bull's Eye - Discontinued 6 Years ago SD-OCT (Spectral domain optical coherence tomography)2102 views82-year-old woman was on Plaquenil from 1976 from 2005, 200 mg a day. It was discontinued because of abnormal visual fields 6 years ago. OD 20/32, OS 20/40Jan 26, 2012
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Plaquenil Toxicity both Eyes - Partial Bull's Eye - Discontinued 6 Years ago SD-OCT (Spectral domain optical coherence tomography)3594 views82-year-old woman was on Plaquenil from 1976 from 2005, 200 mg a day. It was discontinued because of abnormal visual fields 6 years ago. OD 20/32, OS 20/40Jan 26, 2012
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Plaquenil Toxicity both Eyes - Partial Bull's Eye - Discontinued 6 Years ago SD-OCT (Spectral domain optical coherence tomography)3497 views82-year-old woman was on Plaquenil from 1976 from 2005, 200 mg a day. It was discontinued because of abnormal visual fields 6 years ago. OD 20/32, OS 20/40Jan 26, 2012
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Plaquenil Toxicity both Eyes - Partial Bull's Eye - Discontinued 6 Years ago SD-OCT (Spectral domain optical coherence tomography)4173 views82-year-old woman was on Plaquenil from 1976 from 2005, 200 mg a day. It was discontinued because of abnormal visual fields 6 years ago. OD 20/32, OS 20/40Jan 26, 2012
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Plaquenil Toxicity both Eyes - Partial Bull's Eye - Discontinued 6 Years ago SD-OCT (Spectral domain optical coherence tomography)2716 views82-year-old woman was on Plaquenil from 1976 from 2005, 200 mg a day. It was discontinued because of abnormal visual fields 6 years ago. OD 20/32, OS 20/40Jan 26, 2012
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Plaquenil Toxicity both Eyes - Partial Bull's Eye - Discontinued 6 Years ago Fundus Autofluorescence2546 views82-year-old woman was on Plaquenil from 1976 from 2005, 200 mg a day. It was discontinued because of abnormal visual fields 6 years ago. OD 20/32, OS 20/40Jan 26, 2012
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Plaquenil Toxicity both Eyes - Partial Bull's Eye - Discontinued 6 Years ago Fundus Autofluorescence2294 views82-year-old woman was on Plaquenil from 1976 from 2005, 200 mg a day. It was discontinued because of abnormal visual fields 6 years ago. OD 20/32, OS 20/40Jan 26, 2012
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Plaquenil Toxicity both Eyes - Partial Bull's Eye - Discontinued 6 Years ago Fundus Autofluorescence1893 views82-year-old woman was on Plaquenil from 1976 from 2005, 200 mg a day. It was discontinued because of abnormal visual fields 6 years ago. OD 20/32, OS 20/40Jan 26, 2012
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Plaquenil Toxicity both Eyes - Partial Bull's Eye - Discontinued 6 Years ago Fundus Autofluorescence1813 views82-year-old woman was on Plaquenil from 1976 from 2005, 200 mg a day. It was discontinued because of abnormal visual fields 6 years ago. OD 20/32, OS 20/40Jan 26, 2012
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Plaquenil Toxicity both Eyes - Partial Bull's Eye - Discontinued 6 Years ago SD-OCT (Spectral domain optical coherence tomography)1914 views82-year-old woman was on Plaquenil from 1976 from 2005, 200 mg a day. It was discontinued because of abnormal visual fields 6 years ago. OD 20/32, OS 20/40Jan 26, 2012
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Plaquenil Toxicity both Eyes - Partial Bull's Eye - Discontinued 6 Years ago SD-OCT (Spectral domain optical coherence tomography)1631 views82-year-old woman was on Plaquenil from 1976 from 2005, 200 mg a day. It was discontinued because of abnormal visual fields 6 years ago. OD 20/32, OS 20/40Jan 26, 2012
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Plaquenil Toxicity both Eyes - Partial Bull's Eye - Discontinued 6 Years ago InfraRed Image1422 views82-year-old woman was on Plaquenil from 1976 from 2005, 200 mg a day. It was discontinued because of abnormal visual fields 6 years ago. OD 20/32, OS 20/40Jan 26, 2012
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Plaquenil Toxicity both Eyes - Partial Bull's Eye - Discontinued 6 Years ago InfraRed Image1391 views82-year-old woman was on Plaquenil from 1976 from 2005, 200 mg a day. It was discontinued because of abnormal visual fields 6 years ago. OD 20/32, OS 20/40Jan 26, 2012
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Plaquenil Toxicity both Eyes - Partial Bull's Eye - Discontinued 6 Years ago 1363 views82-year-old woman was on Plaquenil from 1976 from 2005, 200 mg a day. It was discontinued because of abnormal visual fields 6 years ago. OD 20/32, OS 20/40Jan 26, 2012
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Plaquenil Toxicity both Eyes - Partial Bull's Eye - Discontinued 6 Years ago 1473 views82-year-old woman was on Plaquenil from 1976 from 2005, 200 mg a day. It was discontinued because of abnormal visual fields 6 years ago. OD 20/32, OS 20/40Jan 26, 2012
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82-year-old woman was seen in the office on January 9, 2012. She was on Plaquenil from 1976 from 2005, 200 mg a day. It was discontinued because of abnormal visual fields. She is having more and more difficulty with glare. The glare she describes as being a problem is just instant. She has oncoming headlights. She has a lot of difficulty seeing or when the sun is in the eyes. It doesn’t sound like it is a light and dark adaptation, it sounds like she adapts pretty well. It is just while lights are in her eyes. She has cataracts, but she also has abnormal maculae and there is some concern about what if anything should be done for her.
VISUAL ACUITY: OD 20/32, OS 20/40. IOP: OD 14, OS 12.
SLIT EXAMINATION: There is 3+ nuclear sclerosis in both eyes.
EXTENDED OPHTHALMOSCOPY:
OD: Vertical C/D ratio is 0.0. There is posterior vitreous separation. There is a bull’s eye pigment irregularity in the macula.
OS: Vertical C/D ratio is 0.1. There is posterior vitreous separation. There is a mild bull’s eye pigment irregularity in the macula.
SPECTRALIS-SD-OCT SCAN: The OCT scan shows typical Plaquenil toxicity without retinal atrophy and a circle around the macula.
FUNDUS AUTO FLUORESCENCE: The fundus auto fluorescence confirms Plaquenil toxicity, worse in the left eye than the right eye with an area in the right eye of hyperfluorescence in the macula and the left eye there is an area of hypofluorescence in the macula. The images are slightly compromised by her cataracts.
IMPRESSION:
1. PLAQUENIL TOXICITY – BOTH EYES WITH BULL’S EYE MACULOPATHY
2. CATARACTS
DISCUSSION: I explained to the patient she does have Plaquenil toxicity with abnormal maculae. She also does have cataracts and I think given her description of her complaints, which are glare with oncoming headlights, there is an excellent chance that cataract surgery will alleviate her symptoms. I told her it is not a hundred percent of herpes, but she does have maculopathy, but probably there is a seventy or eighty percent chance she would have better visual function with the cataract surgery.
She is concerned about possibly getting worse and although it is possible, I think the risk of her getting worse and symptoms being worse with cataract surgery is probably no more than five or ten percent and I suggested she probably should seriously consider that.
