Retinal structural changes after cessation of pentosan polysulfate sodium

Abstract

To quantify baseline and longitudinal structural changes post-cessation in pentosan polysulfate sodium (PPS) retinopathy patients. This is a retrospective cohort study. Retinal thickness and volume of choroidal and hyperreflective retinal pigment epithelium (RPE) excrescences were manually segmented from optical coherence tomography (OCT) volume scans. Baseline measurements were compared against age-matched controls. Longitudinal measurements were performed on patients with follow-up data. Twenty-four eyes of 13 patients were included. At baseline, the mean total retinal thickness was lower in the PPS retinopathy cohort than in age and sex-matched controls (269.1 µm vs. 290.2 µm, p = 0.006). The median (range) of follow-up was 18.6 (4.1 to 34.7) months, with the mean last follow-up of 35.2 months after cessation. During the follow-up period, the thickness of the retina decreased significantly by 11.3 µm (CI: 16.8, 5.8) (p<0.001), with an annual mean decrease of 6.70 µm. However, the mean hyperreflective RPE excrescence volume did not change significantly (p = 0.140) over the follow-up period. Following PPS discontinuation, although RPE excrescence volumes do not change significantly in volume, there continues to be a progressive long-term thinning of the retina which continues at a rate greater than that associated with normal aging. Consequently, long-term follow-up is suggested to monitor patients with PPS maculopathy.