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, 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. Financial Disclosures: Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.