Redefining the Spectrum of Pentosan Polysulfate Retinopathy: Multimodal Imaging Findings from a Cross-Sectional...

Area of Science:

• Ophthalmology
• Retinal Imaging
• Pharmacology

Background:

• Pentosan polysulfate (PPS) is used for interstitial cystitis and osteoarthritis.
• Growing evidence suggests a link between PPS therapy and macular changes.
• Ophthalmic toxicity from PPS requires further investigation.

Purpose of the Study:

• To investigate the impact of pentosan polysulfate (PPS) therapy on vision.
• To describe the spectrum of macular and retinal imaging findings in PPS users.
• To assess the prevalence of retinal toxicity associated with PPS.

Main Methods:

• Cross-sectional screening of 39 current or recent PPS users.
• Standardized visual acuity (VA) testing (ETDRS and Snellen).
• Multimodal imaging including color fundus photography, fundus autofluorescence (FAF), and spectral-domain OCT (SD-OCT).
• Expert grading of imaging for definite toxicity (DT) and questionable toxicity (QT).

Main Results:

• Mean VA was 85 letters (ETDRS) and 20/22 (Snellen).
• Retinopathy observed in 41% of eyes; definite toxicity (DT) in 31%, questionable toxicity (QT) in 10%.
• Retinal pigment epithelium (RPE) abnormalities were present in all DT eyes.
• Unique SD-OCT findings included interdigitation zone abnormalities and 'flying saucer' defects.
• FAF abnormalities occurred in 30.8%, often extending beyond arcades.

Conclusions:

• Multimodal imaging reveals a broader spectrum of structural abnormalities in PPS users.
• Macular changes involve the RPE and outer retina, with findings extending beyond the arcades.
• Clinicians should consider a lower threshold for diagnosing PPS retinopathy due to subtle and atypical findings.