She suffered from Sjogren syndrome and inflammatory arthritis and was currently treated with prednisone and methotrexate. She was previously treated with hydroxychloroquine (Plaquenil) 200mg bid (6.5mg/kg) for 10 years, which was stopped one year prior to presentation. Plaquenil law suits Chloroquine p53 lysosome Trade name chloroquine Patients who present with Plaquenil toxicity typically exhibit depigmentation that is located circumferentially around the macula, giving it a “bull’s eye” pattern. Consequently, this clinical finding is often termed bull’s eye maculopathy. Determination of hydroxychloroquine toxicity Plaquenil toxicity. In general, an abnormal mfERG indicates that the foveal cones and/or bipolar cell layers are dysfunctional and the source of vision loss. Unlike the focal ERG, mfERG also indicates the precise distribution of the retinal dysfunction. Hydroxychloroquine is commonly prescribed for the treatment of rheumatic diseases, particularly systemic lupus erythematosus and rheumatoid arthritis. However, hydroxychloroquine can cause toxicity in the outer retina and the retinal pigment epithelium, producing visual loss. Review of systems: Blurred vision, halos, dry eye, dry mouth, gastroesophageal reflux, joint pain Pupils: Reactive to light in each eye from 5 mm in the dark to 2 mm in the light. Extraocular movements: Full, both eyes (OU) Confrontation visual fields: Full OU Intra-ocular pressure The optic nerves appeared healthy with a 0.3 cup-to-disc ratio. Past Ocular History: None Medical History: Sjogren syndrome and inflammatory arthritis, supraventricular tachycardia, anxiety, depression, peptic ulcer disease Medications: prednisone, methotrexate, amitriptyline, ranitidine, estradiol, tizanidine, diltiazem, Restasis Allergies: codeine, droperidol Family History: heart disease, arthritis, cancer Social History: occasional alcohol but no tobacco or intravenous drug use. Multifocal erg plaquenil toxicity Electroretinography ERG, Multi-focal Electroretinography., Multifocal ERG in Practice - Hydroxychloroquine 200 mg for lupusCutting plaquenil in half causing dosing errors The multifocal electroretinogram multifocal ERG. This is Why You Need Multifocal ERG if You Have Plaquenil Patients. Posted by Diopsys, Inc. on May 2. CQ and hydroxychloroquine HCQ - commonly known as Plaquenil induce retinal toxicity is not well understood. This is Why You Need Multifocal ERG if You Have. Multifocal ERG Guiding Therapy in a Case of.. Multifocal ERG Recording In Patient On Hydroxychloroquine.. Multimodal Imaging in Plaquenil Toxicity. Conversely, multifocal ERG, with its ability to record localized central retinal defects, has gained acceptance as an excellent candidate for detecting subtle changes in the early stages of toxicity. 20 Raj Maturi, MD. Purpose To evaluate the role of multifocal electroretinography mfERG in early detection of hydroxychloroquine HCQ retinal toxicity in patients with connective tissue diseases and to correlate. Although the exact mechanism by which chloroquine CQ and hydroxychloroquine HCQ - commonly known as Plaquenil induce retinal toxicity is not well understood, but it is recognized as a serious ophthalmologic concern because it is not treatable. 1 Guidelines from the American Academy of Ophthalmology AAO on screening for CQ and HCQ toxicity recommend that all patients starting therapy receive a baseline screening followed by annual follow-up visits beginning at 5 years after the start.