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. Hydroxychloroquine bluelight Hydroxychloroquine skin darkening Of note, mfERG can vary 10-30% from session to session and to find definitive changes, a series of mfERG recordings needs to be done9,10 Significant cataracts can affect the outcome of the mfERG12 • In studies, 20-60% of patients receiving Plaquenil were found to have mfERG abnormalities—however, clinically significant hydroxychloroquine Using multifocal ERG ring ratios to detect and follow Plaquenil retinal toxicity A review Review of mfERG ring ratios in Plaquenil toxicity. The patterns of mfERG loss seen herein at various stages of toxicity are similar to what has been observed previously. 4,12 Lai et al 17 suggested that mfERG may show gradual signal loss that correlates with dose and field sensitivity, but it remains to be shown whether such changes can be recognized clinically and prospectively. 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). Mferg plaquenil Don’t Drop Patients on Plaquenil - Review of Optometry, Using multifocal ERG ring ratios to detect and follow. What is the difference between methotrexate and plaquenilDoes plaquenil cause headachesLayers of retina affected with plaquenilPlaquenil and prednisone combination MfERG changes correlate with both structural SD-OCT and functional HVF 10-2 findings in detecting HCQ retinopathy 89, 90. Maturi et al. noted that mfERG changes were associated with a cumulative dose of 500 g and 5 years use and could be classified into four patterns paracentral loss, foveal loss, peripheral loss and generalized loss. Hydroxychloroquine-related retinal toxicity Rheumatology.. Comparison of Screening Procedures in Hydroxychloroquine Toxicity. Plaquenil Oral Uses, Side Effects, Interactions.. The Diopsys® mfERG vision test is a painless, safe, non-invasive way for your eye care provider to objectively measure the function of your retina – the light-sensitive layer at the back of your eye. When light from an image enters your eye, it is turned into electrical energy by cells in the retina. This article is from June 2011 and may contain outdated material. Download PDF. Many systemic medications may cause retinal toxicity. One such commonly used medication for dermatologic and rheumatologic inflammatory conditions is hydroxychloroquine Plaquenil, a chloroquine derivative. One of the reasons that physicians feel comfortable in prescribing Plaquenil is its low risk to benefit ratio. This means that the side effects of Plaquenil are mild and infrequent compared with its potential benefits. As with any medication, allergic reactions including skin rashes and non-allergic reactions can occur.