Case of the Month

July 17, 2023

The Case

The patient was a 78-year-old man who noticed distortion in the right eye for one month. His past medical history is remarkable for a metastasis to the right occipital cortex from lung cancer in 2015, which left him with a left visual field defect. There has been no evidence of active neoplasia subsequently. In our office, he also had Amsler grid changes in the left eye. The visual acuity was 20/40-2 OD and 20/20 OS. Anterior segment examination was remarkable for a posterior chamber IOL without capsular opacity in each eye. Posterior segment examination revealed RPE changes in the macula of each eye without hemorrhages or evident swelling. What is the most likely diagnosis? What treatment, if any, is warranted?

Clinically, the RPE changes are nonspecific, and age-related macular degeneration was suspected. The autofluorescence findings are typical of pentosan polysulfate (Elmiron) retinopathy but not of ARMD. He had taken this medication for many years, and he said that it significantly relieved his symptoms of interstitial cystitis. Pentosan sulfate retinopathy can result in significant visual loss, which can progress after cessation of the medication. I recommended that the medication be discontinued, and hopefully a different medication can relieve the interstitial cystitis if it recurs.

References

Pearce WA, Chen R, Jain N. Pigmentary maculopathy associated with chronic exposure to pentosan polysulfate sodium. Ophthalmology 2018;125:1793-1802.

Huckfeldt RM and Vavvas D. Progressive maculopathy after discontinuation of pentosan polysulfate sodium. Ophthalmic Surg Lasers Imaging Retina 2019;50:656-659.

Case Photos

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