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J. C. Schell, K. E. Stepien, D. P. Han, J. Carroll, J. Rha; Spectral-Domain OCT May Be Able to Detect Plaquenil Toxicity Before Symptomatic Vision Loss Occurs. Invest. Ophthalmol. Vis. Sci. 2009;50(13):3266.
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© ARVO (1962-2015); The Authors (2016-present)
To describe findings in Plaquenil toxicity as seen on Spectral- Domain OCT (SD-OCT) and Adaptive Optics (AO) imaging.
Presentation of two patients with history of Plaquenil use for approximately 20 years. Both were found to have bilateral paracentral superotemporal visual field defects on 10-2 Humphery Visual Field (HVF) testing. Scans were obtained through the macula using the Spectralis SD-OCT (Heidelberg, Heidelberg Germany). Additional images in the parafoveal region were obtained with Adaptive Optics.
SD-OCT images demonstrated loss of photoreceptor inner segment/outer segment junction (IS/OS), thinning of the outer nuclear layer (ONL), and disruption of the outer retinal layers in areas corresponding to HVF defects and funduscopic findings. SD-OCT also showed isolated irregularities in IS/OS junction in areas not detected on HVF. AO imaging showed heterogeneity of the cone photoreceptor mosaic in the perifoveal area.
SD-OCT shows loss of IS/OS junction and disruption of the outer retinal layers in areas of abnormalities demonstrated on 10-2 HVF. Additionally, IS/OS abnormalities are noted in areas that do not show HVF changes, likely indicating areas that are affected by toxicity but have not yet caused visual disturbances. SD-OCT may be able to detect changes in IS/OS junction in early Plaquenil toxicity before symptomatic damage and vision loss occur. AO imaging also shows changes in the cone mosaic in areas of toxicity and may be helpful in detecting toxicity at an earlier stage.
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