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. Chloroquine phosphate injection bp Cyclophosphamide and hydroxychloroquine side effects Hydroxychloroquine how often eye exam PURPOSE To report hydroxychloroquine and chloroquine retinopathy and consider screening for drug toxicity. DESIGN Retrospective observational case series. METHODS Review of clinical records, visual fields, fundus photographs, and fluorescein angiography of six patients from a retina referral practice. Nov 01, 2015 The incidence of retinal toxicity is associated with the cumulative dose of the drug, increasing significantly beyond 1,000 g of HCQ. This cumulative dose is created when the common dose of 400 mg/day is used for 6.8 years. Hydroxychloroquine is metabolized and secreted by both the liver and the kidneys. A pilot study conducted in 15 patients on chloroquine or hydroxychloroquine therapy found that the 10 patients with known or suspected toxicity—based on standardized visual field testing, fluorescein angiography, or both—all demonstrated significant hyperacuity defects on PHP testing. 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. Fluorescein angiography and hydroxychloroquine maculopathy screening Plaquenil Toxicity Screening - Retina Group of New York, Hydroxychloroquine Maculopathy An Update on Screening and. Plaquenil birth control affectsPlaquenil structure Fluorescein Angiography. Fluorescein angiography can recognize subtle RPE defects, but it has not proven to be more sensitive than tests of functional loss or noninvasive retinal imaging. Full-field Electroretinogram. The full-field ERG is a global test of retinal function and will only show abnormalities in very late CQ or HCQ toxicity. Revised Recommendations on Screening for Chloroquine and.. Chloroquine and Hydroxychloroquine Toxicity Workup Approach.. Determine risk for hydroxychloroquine retinal toxicity Optometry Times. The PPP hydroxychloroquine retinopathy screening exams include a comprehensive ophthalmologic evaluation with central visual field assessment by either Amsler grid or Humphrey Visual Field HVF 10-2 perimetry Zeiss, Dublin, CA. Fluorescein angiography may assist in visualizing early subtle changes in the RPE, but it is not considered a screening tool for retinal toxicity. It is critical to counsel patients about the benefits and limitations of screening, underscoring that it can catch toxicity at early stages and minimize vision loss but cannot necessarily prevent all. Figure 2. Spectral-domain optical coherence tomography demonstrating advanced hydroxychloroquine retinopathy with parafoveal loss of the external limiting membrane, disruption of the outer ellipsoid zone, thinning of the outer nuclear layer and disruption to the underlying retinal pigment epithelial layer A.