Blackorby Barton L, Banda Himanshu, Smith Bradley T, Shah Gaurav K
Department of Ophthalmology, Madigan Army Medical Center, Tacoma, WA 98431, USA.
Sound Retina, Tacoma, WA 98405, USA.
Mil Med. 2023 Mar 20;188(3-4):e579-e583. doi: 10.1093/milmed/usab301.
In 2018, a unique maculopathy associated with chronic pentosan polysulfate sodium (PPS) use for the treatment of interstitial cystitis (IC) was described, where the authors detailed macular retinal pigment epithelial abnormalities in six patients. In this paper, a retrospective study of a larger patient pool at one large tertiary retina practice was undertaken to evaluate patients taking PPS and their macular findings.
A retrospective chart review was performed on all patients presenting to a single large retina practice between 2011 and 2019. Patient's macular diagnosis, findings, optical coherence tomography scans, and macular auto-fluorescent scans were assessed. This project was Institutional Review Board (IRB) approved by the St Luke's Hospital IRB board (St Louis, MO, USA).
Fifty-five patients were identified as taking PPS for IC. Fifty-three patients were found to have a diagnosis consistent with changes attributable to known macular diseases to include macular degeneration and pattern dystrophies. Two (4%) of fifty-five patients had macular findings suggestive of PPS toxicity. The first was a 58-year-old female with subtle retinal pigment epithelium (RPE) deposits on optical coherence tomography that exhibited hyper-autofluorescence. The second was a 72-year-old female with 14 years of PPS use who exhibited RPE excrescences and parafoveal areas of atrophy.
Pentosan polysulfate sodium may be the cause of macular findings in a small percentage of patients referred to a tertiary retina practice. Although causation of macular changes with PPS use has yet to be elucidated, clinicians should be aware of this possibility when assessing patients with atypical macular findings. Future longitudinal studies are necessary to evaluate a definitive relationship. This paper should remind all clinicians of the importance of a throughout review of the patient's medication list as novel toxicities may become apparent years after initial FDA trials. The strength of this study is the larger patient population compared to earlier studies, and the main weaknesses include the retrospective nature of the study, lack of family and genetic testing, and lack of multimodal imaging for all patients.
2018年，有文献描述了一种与长期使用戊聚糖多硫酸钠（PPS）治疗间质性膀胱炎（IC）相关的独特黄斑病变，作者详细阐述了6例患者的黄斑视网膜色素上皮异常情况。在本文中，对一家大型三级视网膜诊所的更多患者进行了回顾性研究，以评估服用PPS的患者及其黄斑检查结果。
对2011年至2019年间在一家大型视网膜诊所就诊的所有患者进行回顾性病历审查。评估患者的黄斑诊断、检查结果、光学相干断层扫描以及黄斑自发荧光扫描。该项目获得了美国密苏里州圣路易斯市圣卢克医院机构审查委员会（IRB）的批准。
55例患者被确定正在服用PPS治疗IC。其中53例患者的诊断结果与已知黄斑疾病所致变化相符，包括黄斑变性和图案营养不良。55例患者中有2例（4%）出现提示PPS毒性的黄斑检查结果。第一例是一名58岁女性，光学相干断层扫描显示视网膜色素上皮（RPE）有细微沉积物，表现为高自发荧光。第二例是一名72岁女性，使用PPS达14年，表现为RPE赘生物和黄斑旁萎缩区域。
在转诊至三级视网膜诊所的一小部分患者中，戊聚糖多硫酸钠可能是黄斑检查结果的病因。虽然使用PPS导致黄斑变化的原因尚未阐明，但临床医生在评估有非典型黄斑检查结果的患者时应意识到这种可能性。未来需要进行纵向研究以评估明确的关系。本文应提醒所有临床医生全面审查患者用药清单的重要性，因为新的毒性可能在FDA初始试验数年之后才会显现。本研究的优势在于与早期研究相比患者数量更多，主要不足包括研究的回顾性、缺乏家族和基因检测以及并非所有患者都进行了多模态成像。
