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. Plaquenil price in uae Hydroxychloroquine autophagy Nov 05, 2016 B Nonreproducible central scotoma red arrow in her 10-2 visual field test isn’t typical of hydroxychloroquine retinopathy. C Blue fundus autofluorescence imaging is normal. D Near infrared reflectance imaging shows a hyperreflective annulus yellow arrow which has low sensitivity and specificity for hydroxychloroquine retinopathy. Evaluation by visual field testing and/or spectral domain optical coherence tomography OCT showed the overall prevalence of retinal thinning and photoreceptor damage or visual field loss was 7.5%. The risk climbed with greater daily dosage and duration of therapy, reaching a prevalence of nearly 20% after 20 years on hydroxychloroquine JAMA. The American Academy of Ophthalmology has published several dosing and screening recommendations for hydroxychloroquine to avoid potential retinal toxicity, yet some patients still experience permanent vision loss resulting from hydroxychloroquine retinopathy due to improper dosing of the drug and improper screening. 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). Visual field loss in plaquenil retinopathy How to Succeed in Plaquenil Screenings, Rheumatology News Retinal Hazards of Long Term Plaquenil How long does it take for plaquenil to workPlaquenil side effects gasFda hydroxychloroquinePlaquenil eye Mar 01, 2011 Hydroxychloroquine Plaquenil, Sanofi-Aventis remains widely used in the treatment of various rheumatologic disorders. A small percentage of patients exposed to hydroxychloroquine will develop irreversible, and potentially progressive, retinal toxicity for which no effective treatment exists. New Screening Guidelines for Hydroxychloroquine Toxicity. Despite Plaquenil dosing recommendations, retinal toxicity.. RCOphth guideline Hydroxychloroquine and Chloroquine.. Hydroxychloroquine retinopathy is thought to be infrequent but of increasing prevalence because patients use the drug for many years or have undue exposure from overdosage or renal failure. 1 Screening in previous decades was primarily by subjective functional measures, such as the central visual field. Early signs visual field defects on 10-2 HVF usually paracentral, perifoveal and parafoveal thinning of the retina with loss of the inner/outer segment junction on SD-OCT, increased or decreased signal on autofluorescence, central/paracentral ERG depression on mfERG, +/- changes on Amsler grid, +/- subtle RPE changes, +/- decreased color vision May 16, 2011 It is important to know the facts. Retinal complications from HCQ are actually rare at proper dosage and, with good screening, the risk for visual loss is very low. Nevertheless, retinopathy begins to appear with long-term use, and retinopathy is serious insofar as there is no known treatment.