PMC4371897_01
Case 1.. Notes: Bull's eye maculopathy visible on near-infrared reflectance image (A) but not on autofluorescence (B) or fundus photography (C).
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HC toxicity was diagnosed based on taking a potentially toxic dose of HC in conjunction with a paracentral depression on visual field testing and SD OCT showing paracentral thinning of the outer retinal layers in both eyes (Figure 1A). Although ophthalmoscopy revealed no apparent pigmentary abnormalities, the near infrared reflectance images showed a bull's eye pattern of increased paracentral reflectance (Figure 1A). FAF revealed no evidence of hyperautofluorescence in either macula (Figure 1B). Color fundus photography (Figure 1C) and fluorescein angiography also failed to show a bull's eye maculopathy.
PMC4371897_02
Case 2.. Note: Bull's eye maculopathy visible on near-infrared reflectance image. (A) Central visual field sensitivity loss and (B) multifocal electroretinogram showing weak central waveform signals with (C) bull's eye maculopathy visible on near-infrared image.
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HC toxicity was diagnosed based on taking a potentially toxic dose of HC in conjunction with automated 10-2 visual fields showing central sensitivity loss (Figure 2A), multifocal ERG showing weak central waveform signals (Figure 2B), and SD OCT revealing thinning of the paracentral ellipsoid zone layer. Although ophthalmoscopy revealed no apparent bull's eye maculopathy, the near infrared reflectance image showed a bull's eye pattern of increased reflectivity (Figure 2C).
PMC4371897_03
Case 3.. Notes: Advanced hydroxychloroquine toxicity with loss of outer retinal layers on spectral domain optical coherence tomography (A); marked loss of visual field (B); weak central waveform on multifocal electroretinogram (C); but without bull's eye maculopathy on near-infrared image.
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HC toxicity was diagnosed based on taking a potentially toxic dose of HC in conjunction with diffuse central sensitivity loss on visual field testing (Figure 3B), a weak central waveform signal on multifocal ERG testing (Figure 3C), and a generalized loss of the ellipsoid zone through the fovea and parafoveal macula. The near infrared reflectance image did not show a bull's eye maculopathy (Figure 3A).