Hydroxychloroquine Toxicity with Short Duration of Hydroxychloroquine Use and Unilateral Bull's Eye Maculopathy
Bibliographic record
Abstract
PURPOSE: To report the examination and multimodal imaging findings of a patient with unilateral bull's eye maculopathy. METHODS: A retrospective chart review of a 77-year-old patient with unilateral bull's eye maculopathy who presented to a tertiary retinal practice was performed. The patient's history, visual acuity, examination and multimodal imaging findings over five years of follow-up were described. RESULTS: This 77-year-old Japanese female initially presented with decreased vision in the right eye that had been gradually progressive over years. She had a history of rheumatoid arthritis for which she was initially prescribed hydroxychloroquine 200mg for a five-year period over 20 years prior to presentation. Visual acuity at presentation was 20/30 OD and 20/25 OS with correction. Macular examination and optical coherence tomography revealed a striking bull's eye pattern with a parafoveal ring of atrophy OD, but only subtle and questionable retinal pigment epithelial alterations OS. Fundus autofluorescence did not disclose any abnormalities in the left eye, but the right eye showed a classic bull's eye pattern, with preservation of foveal autofluoresence, a parafoveal hypoautofluorescent ring, and a surrounding outer border of hyperautofluorescence. Follow-up after 5 years showed a stable posterior segment examination. CONCLUSION: We report a case of unilateral bull's eye maculopathy after only a short duration of hydroxychloroquine use. While ocular screening of patients receiving hydroxychloroquine is important, retinal toxicity with a low dose and short duration of use remains rare. Clinicians must retain a broad differential diagnosis in the assessment of patients with bull's eye maculopathy.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.000 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".