CASE REPORT - Retinal toxicity secondary to Plaquenil therapy

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Optometry. 2008 Feb;79(2):90-4.

Retinal toxicity secondary to Plaquenil therapy.

Hanna B, Holdeman NR, Tang RA, Schiffman JS.

University Eye Institute, University of Houston, Houston, Texas, USA.

BHanna.2007@...

BACKGROUND: Hydroxychloroquine sulfate (Plaquenil; Sanofi-Aventis,

Bridgewater, New Jersey) is an antimalarial agent, which is sometimes

used for the treatment of certain autoimmune disorders. Its use has

been associated with ocular side effects; the most concerning is toxic

maculopathy. CASE REPORT: A 71-year-old arthritic white woman

requested a second opinion regarding retinal Plaquenil toxicity. The

patients history was significant for seronegative rheumatoid arthritis

diagnosed 6 years prior. She had taken Plaquenil 400 mg a day for

about 5 years but had discontinued the drug 6 months before when

bilateral central scotomas were first noted. At the consultation

visit, her visual acuities were 20/20 in both eyes. SITA-Standard 10-2

disclosed a dense scotoma with 4 degrees of central sparing in each

eye. Fundus examination found retinal pigment epithelium changes

bilaterally; no " bulls eye " retinopathy was observed.

CONCLUSION: Withdrawal of the medication is the only effective

treatment for Plaquenil toxicity and, even then, the toxic effects may

progress because of the slow clearance of the drug. Though controversy

exists regarding screening recommendations, a baseline ophthalmic

examination should be performed on all patients before initiating

Plaquenil. If a patient is considered low risk, examinations can be

scheduled annually. For high-risk patients, 6-month progress visits

are strongly recommended.

PMID: 18215798

http://www.ncbi.nlm.nih.gov/pubmed/18215798

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