The patient's visual fields were believed to be depressed due to her cataracts and not from Plaquenil use because her central fields had been abnormal since starting the hydroxychloroquine. The color vision defects, however, were a new finding. Fluorescein angiography was performed to ensure macular tissues were healthy. A multifocal ERG (mfERG) was also performed.

Fluorescein Angiography (FA):

No abnormal macular findings OD, OS. The last two photos were taken during the later stages of the FA in both the right and left eye, and neither revealed any macular abnormalities.

Multifocal ERG (mfERG):

	mfERG OD: The reference ERG is on the right and the patient's results on the left. Her results were considered abnormal because the peak to her ERG is significantly lower than the reference ERG.
	mfERG OS: The reference ERG is on the right and the patient's results on the left. Her results in the left eye were found to be slightly abnormal, but not considered significant.

So, does the patient have early signs of toxicity?

Two options discussed with the patient:

• Discontinue the Plaquenil
• Continue Plaquenil with close monitoring every 3 months and repeat mfERG in near future

Assessment:

• Plaquenil toxicity suspected
• Patient refused to repeat mfERG

Plan:

• Discontinued Plaquenil
• Informed rheumatologist of findings

	URL: http://www.opt.indiana.edu/ce/plaq/mgmt.htm Revised: May 7, 2007
	IU Optometry home page: http://www.opt.indiana.edu/ Comments (content): Dr. Julie Torbit at jtorbit@indiana.edu Comments: Web Administrator Page design and coding: Terri Greene Copyright © 2007, The Trustees of Indiana University