Additionally, another exception occurred while executing the custom error page for the first exception. : September 14, 2016 Chief complaint: Whirling and flashing lights A 57-year-old female presented to the Ophthalmology clinic at UIHC complaining bilateral central photopsias for the past two years. Color perception changes in plaquenil Visual prolem with plaquenil Differential diagnosis for plaquenil retinopathy Eye Exam and Testing for Plaquenil. For the first 5 years annual screening is appropriate. In addition to the previous discussion of a thorough complete eye exam with best corrected vision, central visual field, color vision, and dilated retinal exam, other tests include multifocal ERG, spectral domain OCT, and autofluoresence of the macula. The multifocal electroretinogram mfERG technique allows local ERG responses to be recorded simultaneously from many regions of the retina. As in the case of the full-field ERG, the ganglion cells contribute relatively little to the response, which originates largely from the outer retina. 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, and colleagues first reported a marked reduction in the central 16˚ mfERG amplitude in a patient with manifest HCQ retinopathy. She was previously treated with hydroxychloroquine (Plaquenil) 200mg bid (6.5mg/kg) for 10 years, which was stopped one year prior to presentation. She suffered from Sjogren syndrome and inflammatory arthritis and was currently treated with prednisone and methotrexate. Multifocal erg for plaquenil Detection of Early Hydroxychloroquine Retinal Toxicity Enhanced by Ring., The Multifocal Electroretinogram Journal of Neuro-Ophthalmology Plaquenil eye damage reversibleChloroquine phosphate fish dosageCan hydroxychloroquine cause weight gain hair lossHydroxychloroquine sulphate 200mgPlaquenil severe side effects Dr. Marmor said, “We also recommend use of objective tests such as spectral domain OCT, multifocal ERG and fundus autofluorescence.” He added that older time domain OCT units lack enough sensitivity for Plaquenil toxicity. Go by ideal, not real, weight. Dr. Rx Side Effects New Plaquenil Guidelines and More - American Academy.. Multimodal Imaging in Plaquenil Toxicity. PDF Multifocal ERG Guiding Therapy in a Case of Hydroxychloroquine.. Electroretinography ERG In 2015, Tzekov and Madow 8 stated that birdshot chorioretinopathy BSCR is a rare form of autoimmune posterior uveitis that can affect the visual function and, if left untreated, can lead to sight-threatening complications and loss of central vision. Hydroxychloroquine HCQ, brand name Plaquenil is commonly used for the long-term 2 management of a variety of chronic rheumatic diseases including systemic lupus erythematosus 3 and rheumatoid arthritis. A range of potential toxicities related to HCQ use have been reported Twenty patients on Plaquenil treatment were evaluated for retinal toxicity using the EOG and the mfERG. Group 1 comprises 15 patients 30 eyes with normal EOG. From these patients 11 22 eyes showed normal RRD of mfERG in area 1 and area 2. The rest four patients 8 eyes the RRD were reduced. Six months after interruption of HC, the mfERG improved in three cases. Group 2 comprises 5.