CHARACTERIZATION OF PENTOSAN POLYSULFATE SODIUM MACULOPATHY WITH FLUORESCENCE LIFETIME IMAGING

Long-term use of pentosan polysulfate sodium (PPS) for interstitial cystitis has been associated with a sight-threatening pigmentary maculopathy. This study evaluated fluorescence lifetime imaging ophthalmoscopy in PPS maculopathy patients and correlated findings with fundus autofluorescence and optical coherence tomography.

This prospective study included patients with confirmed PPS maculopathy at the University of California, San Diego. All patients underwent same-day multimodal imaging (fluorescence lifetime imaging ophthalmoscopy, fundus photography, fundus autofluorescence, and optical coherence tomography). Disease severity was graded using updated PPS maculopathy criteria. Fluorescence lifetime imaging ophthalmoscopy data were compared with age-matched, sex-matched, and lens status-matched controls.

Nineteen eyes from 10 PPS patients (mean age 71.2) and 19 eyes from 11 age-sex matched normal controls (mean age 71.5) were included. Both groups had seven pseudophakic and four phakic (P) patients. Pentosan polysulfate sodium maculopathy patients showed characteristic fundus autofluorescence changes and retinal pigment epithelium hypertrophy. Disease severity did not significantly differ within or between phakic and pseudophakic groups. Mean fluorescence lifetime imaging ophthalmoscopy lifetimes in PPS eyes were significantly longer than in controls (P: 905 ps vs. 500 ps, P < 0.019), pseudophakic: 557 ps versus 371 ps, P < 0.044). Lifetimes also varied significantly with maculopathy severity ( P < 0.05). In 11 eyes, parafoveal foci with very short lifetimes (273-394 ps) were detected and differed significantly from central values ( P = 0.030).

Fluorescence lifetime imaging ophthalmoscopy detected significant differences in fluorescence lifetimes between PPS maculopathy patients and controls. Discrete very short lifetime foci may represent early or distinct disease features. Fluorescence lifetime imaging ophthalmoscopy is a promising noninvasive tool for diagnosing and monitoring PPS maculopathy.