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. Hydroxychloroquine rx coupon Plaquenil related cardiomyopathy Repeat 10-2 HVF testing demonstrated the dense paracentral scotomas. SD-OCT showed loss of the parafoveal inner/outer segment junction, thinning of the parafoveal outer nuclear layer, and a loss of the normal foveal depression, which is characteristic for hydroxychloroquine retinal toxicity Figure 3. Aug 06, 2014 The relative sparing of the subfoveal structures results in the characteristic “flying saucer” sign of advanced toxicity B.11 While much of the literature has focused on the changes to the outer retina in HCQ retinopathy, the earliest SD-OCT findings of toxicity may actually localize to the inner retina. Sep 15, 2014 Chen E, Brown DM, Benz M, et al. Spectral domain optical coherence tomography as an effective screening test for hydroxychloroquine retinopathy the “flying saucer” sign. Clin Ophthalmol. 2010 Oct 21;51-8. 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. Flying saucer sign oct plaquenil Pacific University College of Optometry, Multimodal Imaging in Plaquenil Toxicity Chloroquine lupus erythematosusHow does chloroquine phosphate work malaria Chen et al. first described the ''flying saucer'' sign of hydroxychloroquine retinopathy, which is an ovoid appearance of the central fovea created by preservation of central foveal outer retinal. PDF Spectral domain optical coherence tomography as an.. Is Damage Still Occurring? - Review of Optometry. SD-OCT As screening test for hydroxychloroquine.. An electroretinogram showed bilateral absent or grossly reduced rod function and grossly reduced cone function. An OCT scan demonstrated the previously described “flying saucer” sign observed in patients with hydroxychloroquine-induced maculopathy. Dec 04, 2014 Recently, there has been some focus on the effects of HCQ on the inner retinal layers. In a study by Pasadhika et al. SD-OCT was applied to measure the thickness of certain segments of the retina in three groups of patients Those with clinical evidence of HCQ retinopathy on fundus examination. Toxicity were found to have significant outer retina disruption in the macula on SD OCT. Three patients with early HCQ toxicity and HVF 10-2 perifoveal defects were found to have loss of the perifoveal photoreceptor inner segment/outer segment IS/OS junction with intact outer retina directly under the fovea, creating the “flying saucer” sign.