间质性膀胱炎患者的色素黄斑病变：与聚硫酸戊聚糖和其他治疗的关系

IF 4.6 Q1 OPHTHALMOLOGY

Ophthalmology science Pub Date : 2025-08-07 DOI:10.1016/j.xops.2025.100909

Sunny Qin MD , Joni K. Evans MS , Chaewon Jeong MD , Margaret Havunjian MD , Nieraj Jain MD , Margaret A. Greven MD , Sally S. Ong MD

{"title":"间质性膀胱炎患者的色素黄斑病变：与聚硫酸戊聚糖和其他治疗的关系","authors":"Sunny Qin MD , Joni K. Evans MS , Chaewon Jeong MD , Margaret Havunjian MD , Nieraj Jain MD , Margaret A. Greven MD , Sally S. Ong MD","doi":"10.1016/j.xops.2025.100909","DOIUrl":null,"url":null,"abstract":"<div><h3>Purpose</h3><div>To examine the association between the development of pigmentary maculopathy and exposure to pentosan polysulfate sodium (PPS) and other therapies in patients with interstitial cystitis (IC).</div></div><div><h3>Design</h3><div>Single-center retrospective study.</div></div><div><h3>Subjects</h3><div>Patients diagnosed with IC who had ≥2 eye examinations at Wake Forest School of Medicine between January 2011 and August 2021.</div></div><div><h3>Methods</h3><div>Two masked retina specialists evaluated available multimodal imaging for pigmentary maculopathy using the established criteria, with any disagreements adjudicated by a third reviewer. Cases were categorized by severity and analyzed for associations with medication exposure.</div></div><div><h3>Main Outcome Measures</h3><div>Association between the development of pigmentary maculopathy with PPS exposure duration and cumulative dose, and concurrent IC medication use.</div></div><div><h3>Results</h3><div>A total of 336 patients with IC (176 with PPS exposure, 160 without) were included. Patients with PPS exposure had increased odds of exposure to hydroxyzine (odds ratio [OR]: 4.76, <em>P</em> < 0.0001), amitriptyline (OR: 2.62, <em>P</em> < 0.0002), phenazopyridine or pyridium (OR: 1.68, <em>P</em> = 0.036), narcotics (OR: 2.68, <em>P</em> < 0.0001), oxybutynin (OR: 1.93, <em>P</em> = 0.041), cystoscopy with hydrodistention (OR: 4.001, <em>P</em> < 0.0001), bladder instillation (OR: 6.83, <em>P</em> < 0.0001), and vaginal valium (OR: 9.515, <em>P</em> = 0.033). Of the 122 patients with retinal imaging (71 with PPS exposure, 51 without), 8 patients (16 eyes) were graded to have pigmentary maculopathy and all 8 patients had PPS exposure. The median duration of PPS exposure in patients with moderate/severe maculopathy was 121 months (interquartile range [IQR] 117, 121) with a median cumulative dose of 929 200 mg (IQR 799 200; 1 109 100), which were significantly higher than patients with mild or no maculopathy (median duration 35 months [IQR 10, 63], <em>P</em> = 0.002 and median dose 166 800 mg [IQR 44 600; 569 100], <em>P</em> = 0.004). Higher proportions of patients with pigmentary maculopathy than those without had concurrent exposure to PPS and amitriptyline/nortriptyline (75% vs. 34.9%, <em>P</em> = 0.015) or PPS and cyclosporine (37.5% vs. 1.6%, <em>P</em> = 0.003).</div></div><div><h3>Conclusions</h3><div>Pentosan polysulfate sodium exposure, and not IC itself, was associated with the development of pigmentary maculopathy. Longer duration and higher cumulative dose were associated with worse maculopathy. Patients on PPS were more likely to be on multiple other therapies for IC. Concurrent exposure to PPS and amitriptyline/nortriptyline or cyclosporine may increase the risk of developing maculopathy but these results should be validated by larger prospective studies.</div></div><div><h3>Financial Disclosure(s)</h3><div>Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.</div></div>","PeriodicalId":74363,"journal":{"name":"Ophthalmology science","volume":"6 1","pages":"Article 100909"},"PeriodicalIF":4.6000,"publicationDate":"2025-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Pigmentary Maculopathy in Patients with Interstitial Cystitis: Association with Pentosan Polysulfate and Other Therapies\",\"authors\":\"Sunny Qin MD , Joni K. Evans MS , Chaewon Jeong MD , Margaret Havunjian MD , Nieraj Jain MD , Margaret A. Greven MD , Sally S. Ong MD\",\"doi\":\"10.1016/j.xops.2025.100909\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Purpose</h3><div>To examine the association between the development of pigmentary maculopathy and exposure to pentosan polysulfate sodium (PPS) and other therapies in patients with interstitial cystitis (IC).</div></div><div><h3>Design</h3><div>Single-center retrospective study.</div></div><div><h3>Subjects</h3><div>Patients diagnosed with IC who had ≥2 eye examinations at Wake Forest School of Medicine between January 2011 and August 2021.</div></div><div><h3>Methods</h3><div>Two masked retina specialists evaluated available multimodal imaging for pigmentary maculopathy using the established criteria, with any disagreements adjudicated by a third reviewer. Cases were categorized by severity and analyzed for associations with medication exposure.</div></div><div><h3>Main Outcome Measures</h3><div>Association between the development of pigmentary maculopathy with PPS exposure duration and cumulative dose, and concurrent IC medication use.</div></div><div><h3>Results</h3><div>A total of 336 patients with IC (176 with PPS exposure, 160 without) were included. Patients with PPS exposure had increased odds of exposure to hydroxyzine (odds ratio [OR]: 4.76, <em>P</em> < 0.0001), amitriptyline (OR: 2.62, <em>P</em> < 0.0002), phenazopyridine or pyridium (OR: 1.68, <em>P</em> = 0.036), narcotics (OR: 2.68, <em>P</em> < 0.0001), oxybutynin (OR: 1.93, <em>P</em> = 0.041), cystoscopy with hydrodistention (OR: 4.001, <em>P</em> < 0.0001), bladder instillation (OR: 6.83, <em>P</em> < 0.0001), and vaginal valium (OR: 9.515, <em>P</em> = 0.033). Of the 122 patients with retinal imaging (71 with PPS exposure, 51 without), 8 patients (16 eyes) were graded to have pigmentary maculopathy and all 8 patients had PPS exposure. The median duration of PPS exposure in patients with moderate/severe maculopathy was 121 months (interquartile range [IQR] 117, 121) with a median cumulative dose of 929 200 mg (IQR 799 200; 1 109 100), which were significantly higher than patients with mild or no maculopathy (median duration 35 months [IQR 10, 63], <em>P</em> = 0.002 and median dose 166 800 mg [IQR 44 600; 569 100], <em>P</em> = 0.004). Higher proportions of patients with pigmentary maculopathy than those without had concurrent exposure to PPS and amitriptyline/nortriptyline (75% vs. 34.9%, <em>P</em> = 0.015) or PPS and cyclosporine (37.5% vs. 1.6%, <em>P</em> = 0.003).</div></div><div><h3>Conclusions</h3><div>Pentosan polysulfate sodium exposure, and not IC itself, was associated with the development of pigmentary maculopathy. Longer duration and higher cumulative dose were associated with worse maculopathy. Patients on PPS were more likely to be on multiple other therapies for IC. Concurrent exposure to PPS and amitriptyline/nortriptyline or cyclosporine may increase the risk of developing maculopathy but these results should be validated by larger prospective studies.</div></div><div><h3>Financial Disclosure(s)</h3><div>Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.</div></div>\",\"PeriodicalId\":74363,\"journal\":{\"name\":\"Ophthalmology science\",\"volume\":\"6 1\",\"pages\":\"Article 100909\"},\"PeriodicalIF\":4.6000,\"publicationDate\":\"2025-08-07\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Ophthalmology science\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S2666914525002076\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"OPHTHALMOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Ophthalmology science","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2666914525002076","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"OPHTHALMOLOGY","Score":null,"Total":0}

引用次数: 0

摘要

目的探讨间质性膀胱炎（IC）患者的色素性黄斑病变与戊聚糖聚硫酸钠（PPS）及其他治疗方法的关系。设计：单中心回顾性研究。受试者：2011年1月至2021年8月期间在维克森林医学院进行≥2次眼科检查的诊断为IC的患者。方法两名蒙面视网膜专家使用既定标准评估可用的多模态成像对色素性黄斑病变，任何分歧由第三审稿人裁决。病例按严重程度分类，并分析与药物暴露的关系。主要观察指标：色素性黄斑病变的发生与PPS暴露时间、累积剂量以及同时使用IC药物有关。结果共纳入336例IC患者（176例暴露于PPS， 160例未暴露于PPS）。暴露于PPS的患者暴露于羟嗪（比值比[OR]: 4.76, P < 0.0001）、阿米替林（比值比：2.62,P < 0.0002）、非那唑吡啶或吡啶（比值比：1.68,P = 0.036）、麻醉药（比值比：2.68,P < 0.0001）、羟布宁（比值比：1.93,P = 0.041）、膀胱镜检查（比值比：4.001,P < 0.0001）、膀胱输液（比值比：6.83,P < 0.0001）和阴道镇静剂（比值比：9.515,P = 0.033）的几率增加。在122例视网膜成像患者中（71例有PPS暴露，51例没有），8例（16只眼睛）被分级为色素黄斑病变，8例患者均有PPS暴露。中/重度黄斑病变患者PPS暴露的中位持续时间为121个月（四分位数间距[IQR] 117,121），中位累积剂量为929 200 mg (IQR 799 200; 1 109 100)，显著高于轻度或无黄斑病变患者（中位持续时间35个月[IQR 10, 63], P = 0.002，中位剂量为166 800 mg [IQR 44 600； 569 100], P = 0.004）。同时暴露于PPS和阿米替林/去甲替林（75% vs. 34.9%, P = 0.015）或PPS和环孢素（37.5% vs. 1.6%, P = 0.003）的色素黄斑病变患者比例高于未暴露于PPS和阿米替林/去甲替林（34.9%,P = 0.015）的患者。结论聚硫酸戊糖钠暴露与色素黄斑病变的发生有关，而与IC本身无关。持续时间越长，累积剂量越大，黄斑病变越严重。服用PPS的患者更有可能同时接受多种其他治疗。同时服用PPS和阿米替林/去甲替林或环孢素可能会增加发生黄斑病变的风险，但这些结果应通过更大规模的前瞻性研究来验证。财务披露专有或商业披露可在本文末尾的脚注和披露中找到。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

查看原文本刊更多论文

Pigmentary Maculopathy in Patients with Interstitial Cystitis: Association with Pentosan Polysulfate and Other Therapies

Purpose

To examine the association between the development of pigmentary maculopathy and exposure to pentosan polysulfate sodium (PPS) and other therapies in patients with interstitial cystitis (IC).

Design

Single-center retrospective study.

Subjects

Patients diagnosed with IC who had ≥2 eye examinations at Wake Forest School of Medicine between January 2011 and August 2021.

Methods

Two masked retina specialists evaluated available multimodal imaging for pigmentary maculopathy using the established criteria, with any disagreements adjudicated by a third reviewer. Cases were categorized by severity and analyzed for associations with medication exposure.

Main Outcome Measures

Association between the development of pigmentary maculopathy with PPS exposure duration and cumulative dose, and concurrent IC medication use.

Results

A total of 336 patients with IC (176 with PPS exposure, 160 without) were included. Patients with PPS exposure had increased odds of exposure to hydroxyzine (odds ratio [OR]: 4.76, P < 0.0001), amitriptyline (OR: 2.62, P < 0.0002), phenazopyridine or pyridium (OR: 1.68, P = 0.036), narcotics (OR: 2.68, P < 0.0001), oxybutynin (OR: 1.93, P = 0.041), cystoscopy with hydrodistention (OR: 4.001, P < 0.0001), bladder instillation (OR: 6.83, P < 0.0001), and vaginal valium (OR: 9.515, P = 0.033). Of the 122 patients with retinal imaging (71 with PPS exposure, 51 without), 8 patients (16 eyes) were graded to have pigmentary maculopathy and all 8 patients had PPS exposure. The median duration of PPS exposure in patients with moderate/severe maculopathy was 121 months (interquartile range [IQR] 117, 121) with a median cumulative dose of 929 200 mg (IQR 799 200; 1 109 100), which were significantly higher than patients with mild or no maculopathy (median duration 35 months [IQR 10, 63], P = 0.002 and median dose 166 800 mg [IQR 44 600; 569 100], P = 0.004). Higher proportions of patients with pigmentary maculopathy than those without had concurrent exposure to PPS and amitriptyline/nortriptyline (75% vs. 34.9%, P = 0.015) or PPS and cyclosporine (37.5% vs. 1.6%, P = 0.003).

Conclusions

Pentosan polysulfate sodium exposure, and not IC itself, was associated with the development of pigmentary maculopathy. Longer duration and higher cumulative dose were associated with worse maculopathy. Patients on PPS were more likely to be on multiple other therapies for IC. Concurrent exposure to PPS and amitriptyline/nortriptyline or cyclosporine may increase the risk of developing maculopathy but these results should be validated by larger prospective studies.