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Shiri Shulman, zohar Habot-Wilner, Michaela Goldstein, Meira Neudorfer, Dafna Goldenberg; Sd Oct Macular Findings In Patients Treated With Hydroxychloroquine. Invest. Ophthalmol. Vis. Sci. 2012;53(14):822.
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Hydroxychloroquine (Plaquinil) is widely used in the treatment of rheumatic diseases, and its prolonged use may be associated with irreversible macular a toxicity. Our purpose was to evaluate the sensitivity and specificity of routine SD OCT exam in the follow up of patients treated with Plaquinil.
Prospective case series. Patients treated with Plaquinil for systemic disorders such as Systemic Lupus erythematosis (SLE) and Rheumatoid Arthritis (RA) underwent an ophthalmological examination. Demographic data including the systemic disease and medications, as well as the duration of plaquinil use, daily dosage and cumulative dosage were collected.All patients underwent a complete ophthalmologic examination, including biomicroscopic examination, Humphry 10-2 visual field test, spectralis SD OCT macular imaging.
Thirty two patients were included in the study. . There were 4 men and 28 women . The mean age was 55.7 years (range 19-83 ). The most common diagnosis was SLE in 17 patients. The mean duration of plaquinil use was 5.3 years (range 2-10 years) and the mean cumulative dose was 864.6 gr.In 11 patients (34%) all screening tests were normal.7 patients (21.8% ) had fundus changes suspicious of plaquinil toxicity in biomicroscopic examination and 9 patients (28%) had parafoveal scotomata in visual field test. .11 patients (34%) had OCT findings . 8 patients had non specific OCT changes including retinal pigment epithelial (RPE) irregularities, Pigment epithelial detachment (PED) drusen, and Epiretinal membranes, and 3 patients had changes suggestive of plaquinil toxicity demonstrating perifoveal thinning or complete loss of the inner-outer segment layer of the photorecptor. .Allt these 3 patients had both visual field defects and mild perifoveal RPE changes on fundus examination.
In patients treated with Plaquinil visual field testing and fundus examination are highly sensitive but non specific screening tool . SD OCT is a sensitive and specific modality and should be included in the routine follow up of these patients.
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