Chloroquine is now uncommonly used in favor of its derivative hydroxychloroquine. In the United States, hydroxychloroquine is most often used for its anti-inflammatory effects in rheumatology and dermatology. Plaquenil treatment rheumatoid arthritis Plaquenil history The outer nuclear layer is thinner in eyes with pachychoroid pigment epitheliopathy than eyes with uncomplicated pachychoroid and eyes of healthy subjects. The degenerative process of pachychoroid spectrum diseases may begin with retinal pigment epithelium alterations before subretinal fluid accumulation. Thinning of the peripapillary retinal nerve fiber layer pRNFL and ganglion cell + inner plexiform layer GCIP, observed on optical coherence tomography OCT, are known to be accelerated in MS, even in the absence of optic neuritis, which is common in MS. Parafoveal thinning of the outer nuclear layer follows, before retinal pigment epithelium damage is visible. Careful screening with multiple tests can detect toxic damage before prominent loss of the outer nuclear layer. While early toxicity may be asymtomatic, patients with more advanced stage of toxicity may complain of color vision changes or paracentral scotomas. Its toxic effects on the retina are seen in the macula. Plaquenil and thinning outer nuclear layer of retina Multimodal Imaging in Plaquenil Toxicity, Retinal Layer Thinning in MS Advances With Disease Progression Aao plaquenil guidelinesSide effects of long term plaquenil use Aug 08, 2018 This relative thinning of outer retinas was caused by a thinning of two specific portions of the outer retina the outer nuclear layer ONL and ellipsoid zone EZ. Eye Exam May Aid Diagnosis of Frontotemporal Dementia. Comparison of Screening Procedures in Hydroxychloroquine Toxicity. Cell death in the inner and outer nuclear layers of the.. The choroidal vasculature supplies the outer one-third of the inner nuclear layer, outer plexiform layer, outer nuclear layer, photoreceptors, and RPE. Because of this division of the blood supply to the retina, ischemic choroidal vascular lesions and ischemic lesions attributed to the retinal vasculature produce different histologic pictures. The inner retinal layers are significantly thicker and hyperreflective from the acute infaract. After the initial acute phase of the retina artery occlusion, the swollen inner retinal layers will start to atrophy. OCT scans will display thin inner retinal layers with fairly normal outer retinal layers. Outer nuclear layer ONL thinning was present in 100 % and observed as a focal indentation in the parafoveal ONL when compared to peripheral ONL thickness. Disruption of the parafoveal interdigitation zone IZ was recorded in 88 % and reduced reflectivity of the parafoveal EZ band in the absence of definitive disruption was observed in 50 %.