title: New trends in early diagnosis of hydroxychloroquine toxic retinopathy.
abstract: BACKGROUND
  Toxic retinopathy is an uncommon sequella in the treatment of certain autoimmune diseases with hydroxychloroquine (HCQ).  We present two cases of HCQ toxic retinopathy, as well as a discussion on how to diagnose and manage early toxicity findings;
  
  
  METHODS
  Two cases are presented of patients who experienced toxic effects of HCQ therapy.  The first patient had bull's eye maculopathy confirmed with visual field testing and optical coherence tomography (OCT).  The second patient had early signs of toxic maculopathy validated by repeat visual field and OCT testing;
  
  
  CONCLUSIONS
  Management of toxic maculopathy includes the cessation of hydroxychloroquine, continued monitoring of the toxic effects and optimizing the remaining vision.  The irreversible and potential devastating effect of HCQ toxic maculopathy underscores the importance of early diagnosis and working with the patient's rheumatologist.
authors.affiliation: Sioux Falls Veterans Affairs Health Care System, 2501 W. 22nd Street, Sioux Falls, SD 57017, USA. Gary.Vanderzee@va.gov
authors.forename: Gary
authors.initials: G
authors.lastname: Vanderzee
authors.forename: Douglas
authors.initials: D
authors.lastname: Tassi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D018501:Antirheumatic Agents / Q000009:adverse effects / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000188:drug therapy; D003937:Diagnosis, Differential; D042241:Early Diagnosis; D004596:Electroretinography; D005500:Follow-Up Studies; D006801:Humans; D006886:Hydroxychloroquine / Q000009:adverse effects* / Q000627:therapeutic use; D008297:Male; D012160:Retina / Q000187:drug effects* / Q000473:pathology / Q000503:physiopathology; D012164:Retinal Diseases / Q000139:chemically induced* / Q000175:diagnosis; D041623:Tomography, Optical Coherence; D014794:Visual Fields
chemical_list: D018501:Antirheumatic Agents; D006886:Hydroxychloroquine