She suffered from Sjogren syndrome and inflammatory arthritis and was currently treated with prednisone and methotrexate. She was previously treated with hydroxychloroquine (Plaquenil) 200mg bid (6.5mg/kg) for 10 years, which was stopped one year prior to presentation. Is plaquenil an anticoagulant Mylan hydroxychloroquine high Plaquenil prescribed by rheumatologist cut in half And quantified using ERG. Which type of ERG to apply depends on the mechanism and site of retinal toxic-ity. Identifying retinal toxicity due to chloroquine or hydroxychloroquine is a pertinent application of mfERG. SIGNS OF TOXICITY Plaquenil toxicity first affects small areas of the retina between 5° and 15° from the fovea. Figures 2 and 3 show Patients who present with Plaquenil toxicity typically exhibit depigmentation that is located circumferentially around the macula, giving it a “bull’s eye” pattern. Consequently, this clinical finding is often termed bull’s eye maculopathy. Although multifocal electroretinogram mfERG and fundus autofluorescence FAF are not currently primary tests used in the evaluation of Plaquenil retinal toxicity, they may be beneficial when the diagnosis or findings are enigmatic or an adjunct test is warranted. Review of systems: Blurred vision, halos, dry eye, dry mouth, gastroesophageal reflux, joint pain Pupils: Reactive to light in each eye from 5 mm in the dark to 2 mm in the light. Extraocular movements: Full, both eyes (OU) Confrontation visual fields: Full OU Intra-ocular pressure The optic nerves appeared healthy with a 0.3 cup-to-disc ratio. Past Ocular History: None Medical History: Sjogren syndrome and inflammatory arthritis, supraventricular tachycardia, anxiety, depression, peptic ulcer disease Medications: prednisone, methotrexate, amitriptyline, ranitidine, estradiol, tizanidine, diltiazem, Restasis Allergies: codeine, droperidol Family History: heart disease, arthritis, cancer Social History: occasional alcohol but no tobacco or intravenous drug use. Multifocal erg plaquenil toxicity Evaluation of Hydroxychloroquine Retinopathy With., Pause the Plaquenil? Plaquenil cause menstrual cycle Assessing hydroxychloroquine toxicity by the multifocal ERG. Doc Ophthalmol. 2004; 1081. Twenty patients on Plaquenil treatment were evaluated for retinal toxicity using the EOG and the mfERG. Group 1 comprises 15 patients 30 eyes with normal EOG. Assessing hydroxychloroquine toxicity by the multifocal ERG.. How to Succeed in Plaquenil Screenings. Using multifocal ERG ring ratios to detect and. The multifocal electroretinogram multifocal ERG. This is Why You Need Multifocal ERG if You Have Plaquenil Patients. Posted by Diopsys, Inc. on May 2. CQ and hydroxychloroquine HCQ - commonly known as Plaquenil induce retinal toxicity is not well understood. Determination of hydroxychloroquine toxicity Plaquenil toxicity. In general, an abnormal mfERG indicates that the foveal cones and/or bipolar cell layers are dysfunctional and the source of vision loss. Unlike the focal ERG, mfERG also indicates the precise distribution of the retinal dysfunction. Using multifocal ERG ring ratios to detect and follow Plaquenil retinal toxicity a review. Abstract. Multifocal ERG ring ratios provide a sensitive and objective method to detect ocular toxicity in patients taking hydroxychloroquine Plaquenil.