{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,23]],"date-time":"2026-01-23T08:50:59Z","timestamp":1769158259434,"version":"3.49.0"},"reference-count":15,"publisher":"Oxford University Press (OUP)","issue":"3-4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,3,20]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Materials and methods<\/jats:title><jats:p>A retrospective chart review was performed on all patients presenting to a single large retina practice between 2011 and 2019. Patient\u2019s 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\u2019s Hospital IRB board (St Louis, MO, USA).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>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\u2009years of PPS use who exhibited RPE excrescences and parafoveal areas of atrophy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>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\u2019s 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.<\/jats:p><\/jats:sec>","DOI":"10.1093\/milmed\/usab301","type":"journal-article","created":{"date-parts":[[2021,7,23]],"date-time":"2021-07-23T06:20:34Z","timestamp":1627021234000},"page":"e579-e583","source":"Crossref","is-referenced-by-count":4,"title":["Macular Findings of Patients on Pentosan Polysulfate Sodium"],"prefix":"10.1093","volume":"188","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5302-1302","authenticated-orcid":false,"given":"Barton L","family":"Blackorby","sequence":"first","affiliation":[{"name":"Department of Ophthalmology, Madigan Army Medical Center , Tacoma, WA 98431, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Himanshu","family":"Banda","sequence":"additional","affiliation":[{"name":"Sound Retina , Tacoma, WA 98405, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bradley T","family":"Smith","sequence":"additional","affiliation":[{"name":"The Retina Institute , St Louis, MO 63144, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gaurav K","family":"Shah","sequence":"additional","affiliation":[{"name":"The Retina Institute , St Louis, MO 63144, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2021,7,23]]},"reference":[{"issue":"5","key":"2023033100401077900_","doi-asserted-by":"crossref","first-page":"535","DOI":"10.1016\/j.ophtha.2019.10.036","article-title":"Pentosan polysulfate sodium exposure and drug-induced maculopathy in commercially insured patients in the United States","volume":"127","author":"Ludwig","year":"2020","journal-title":"Ophthalmology"},{"key":"2023033100401077900_","article-title":"Elmiron (pentosan polysulfate sodium) [package insert]. U.S. Food and Drug Administration website","author":"Janssen Pharmaceutical Companies"},{"issue":"11","key":"2023033100401077900_","doi-asserted-by":"crossref","first-page":"1793","DOI":"10.1016\/j.ophtha.2018.04.026","article-title":"Pigmentary maculopathy associated with chronic exposure to pentosan polysulfate sodium","volume":"125","author":"Pearce","year":"2018","journal-title":"Ophthalmology"},{"issue":"5","key":"2023033100401077900_","first-page":"293","article-title":"Retinopathy induced by drugs and herbal medicines","volume":"12","author":"Nencini","year":"2008","journal-title":"Eur Rev Med Pharmacol Sci"},{"issue":"2","key":"2023033100401077900_","doi-asserted-by":"crossref","first-page":"252","DOI":"10.3390\/pharmaceutics4020252","article-title":"Breakdown of the blood-ocular barrier as a strategy for the systemic use of nanosystems","volume":"4","author":"Occhiutto","year":"2012","journal-title":"Pharmaceutics"},{"issue":"10","key":"2023033100401077900_","doi-asserted-by":"crossref","first-page":"1464","DOI":"10.1016\/j.ophtha.2019.04.024","article-title":"Strength of association between pentosan polysulfate and a novel maculopathy","volume":"126","author":"Hanif","year":"2019","journal-title":"Ophthalmology"},{"issue":"10","key":"2023033100401077900_","doi-asserted-by":"crossref","first-page":"656","DOI":"10.3928\/23258160-20191009-10","article-title":"Progressive maculopathy after discontinuation of pentosan polysulfate sodium","volume":"50","author":"Huckfeldt","year":"2019","journal-title":"Ophthalmic Surg Lasers Imaging Retin"},{"issue":"2","key":"2023033100401077900_","doi-asserted-by":"crossref","first-page":"116","DOI":"10.1016\/j.jcjo.2019.12.001","article-title":"Pentosan-associated maculopathy: prevalence, screening guidelines, and spectrum of findings based on prospective multimodal analysis","volume":"55","author":"Wang","year":"2020","journal-title":"Can J Ophthalmol"},{"issue":"5","key":"2023033100401077900_","doi-asserted-by":"crossref","first-page":"402","DOI":"10.1212\/CPJ.0000000000000027","article-title":"Fingolimod and macular edema: pathophysiology, diagnosis, and management","volume":"4","author":"Cugati","year":"2014","journal-title":"Neurol Clin Pract"},{"issue":"1","key":"2023033100401077900_","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/BF00153873","article-title":"Toxic effects of phenothiazines on the retina","volume":"28","author":"Boet","year":"1970","journal-title":"Doc Ophthalmol"},{"issue":"3","key":"2023033100401077900_","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1080\/08820530802049962","article-title":"Ocular toxicity of hydroxychloroquine","volume":"23","author":"Tehrani","year":"2008","journal-title":"Semin Ophthalmol"},{"issue":"3","key":"2023033100401077900_","first-page":"322","article-title":"Retinal toxicity associated with chronic exposure to hydroxychloroquine and its ocular screening. Review","volume":"7","author":"Geam\u0103nu Panc\u0103","year":"2014","journal-title":"J Med Life"},{"issue":"2","key":"2023033100401077900_","doi-asserted-by":"crossref","first-page":"413","DOI":"10.2147\/OPTH.S2151","article-title":"Age and disease-related structural changes in the retinal pigment epithelium","volume":"2","author":"Bonilha","year":"2008","journal-title":"Clin Ophthalmol"},{"issue":"12","key":"2023033100401077900_","doi-asserted-by":"crossref","first-page":"1596","DOI":"10.1001\/archophthalmol.2009.326","article-title":"Outer retinal tubulation: a novel optical coherence tomography finding","volume":"127","author":"Zweifel","year":"2009","journal-title":"Arch Ophthalmol"},{"issue":"10","key":"2023033100401077900_","doi-asserted-by":"crossref","first-page":"1979","DOI":"10.1097\/IAE.0000000000000609","article-title":"Outer retinal tubulation: characteristics in patients with neovascular age-related macular degeneration","volume":"35","author":"Iaculli","year":"2015","journal-title":"Retina"}],"container-title":["Military Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/milmed\/article-pdf\/188\/3-4\/e579\/49703411\/usab301.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/milmed\/article-pdf\/188\/3-4\/e579\/49703411\/usab301.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,11,6]],"date-time":"2023-11-06T11:01:41Z","timestamp":1699268501000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/milmed\/article\/188\/3-4\/e579\/6326433"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,7,23]]},"references-count":15,"journal-issue":{"issue":"3-4","published-online":{"date-parts":[[2021,7,23]]},"published-print":{"date-parts":[[2023,3,20]]}},"URL":"https:\/\/doi.org\/10.1093\/milmed\/usab301","relation":{},"ISSN":["0026-4075","1930-613X"],"issn-type":[{"value":"0026-4075","type":"print"},{"value":"1930-613X","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2023,3,1]]},"published":{"date-parts":[[2021,7,23]]}}}