Evaluating for pentosan polysulfate maculopathy at a single academic institution

Area of Science:

• Ophthalmology
• Pharmacology
• Toxicology

Background:

• Pentosan polysulfate sodium (PPS) is used for interstitial cystitis.
• Ocular toxicity, specifically maculopathy, has been associated with long-term PPS use.
• Early detection and monitoring of PPS maculopathy are crucial for patient outcomes.

Purpose of the Study:

• To document the practices and outcomes of ophthalmic evaluations for pentosan polysulfate sodium (PPS) maculopathy.
• To identify the prevalence and characteristics of PPS maculopathy at a single institution.
• To assess the adequacy of imaging modalities in evaluating PPS toxicity.

Main Methods:

• Retrospective review of patients with documented PPS exposure and ophthalmic encounters (2019-2022).
• Analysis of examination components, including optical coherence tomography (OCT), fundus autofluorescence (FAF), and color fundus photography (CFP).
• Identification and characterization of PPS maculopathy cases based on clinical findings and imaging.

Main Results:

• Thirty-seven patients with PPS exposure were included.
• Inadequate documentation of OCT, FAF, and CFP was noted for toxicity evaluation.
• Four cases (10.8%) of PPS maculopathy were identified, with some cases showing progression post-cessation.
• Maculopathy onset was associated with over 15 years of exposure and >2000 mg cumulative dose.

Conclusions:

• Inadequate imaging and documentation hinder the evaluation of PPS toxicity.
• This study adds four cases to the literature on PPS maculopathy, including post-cessation progression.
• Post-cessation evaluations are necessary to monitor for maculopathy progression and prevent misdiagnosis.