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The
patient is a 54 year old woman with 13 year history of
lupus who has been taking Plaquenil at 400 mg a day for
at least ten years. She was in for a recent
examination with some complaints of blurring of vision.
Annular RPE changes were noted, and Plaquenil toxicity
suspected. Her past ocular history otherwise has been
notable only for "red eyes". She has
been complaining of a "round spot" in the left
eye for the last six months or so.
Click
on the images, below, to enlarge
Her visual
acuity was 20/25- OD and 20/30- OS. She read J1 OU.
Her color vision testing showed 7 out of 15 with each
eye. Slit lamp examination bilaterally showed
early nuclear cataracts. She had a trace posterior
subcapsular cataract on the right side. Dilated
fundus exam (see color photos) of the right eye shows a
cup/disc ratio of 0.5 and normal appearing vessels.
The macula shows pigmentary changes in an oval pattern.
This is a bit more prominent inferiorly. This is
somewhat of a bulls-eye pattern. The macula
otherwise is normal. The periphery is
unremarkable. Left fundus examination shows a more
definite bulls eye type pattern that is somewhat oval.
There is some RPE mottling centrally. The macula
and periphery are otherwise normal.
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20/25 OD
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20/30
OS
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Fluorescein angiography
with transit on the right side was performed. (see FA)
This shows an inferior semi-circle of RPE window defect
which shows constant transmission throughout the study
and no staining or leakage. In the left eye, she
has a larger area of oval hyperfluorescence and
transmission defect. (See
pictures)
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FA
Early 1
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FA
Early 2
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FA
Early 3
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FA Mid OS
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FA Late OD
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FA Late OS
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Any
further testing recommended? Diagnosis? Recommendations?
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