Çağrı DOĞAN, Arzu MALAK, Murat AKGÜL, Cenk Murat YAZICI, Banu SARIFAKIOĞLU, Tansu GÖNEN, Hulusi DAYISOYLU, Ece KARASU GÜNDER

EVALUATION OF THE ASSOCIATION OF PIGMENTARY MACULOPATHY IN PRIMARY BLADDER PAIN SYNDROME PATIENTS RECEIVING PENTOSAN POLYSULFATE SODIUM TREATMENT

Objective Primary bladder pain syndrome (PBPS) is characterized with suprapubic pain accompanied by at least one lower urinary tract symptoms including frequent urination, urinary urgency and nocturia for more than 6 weeks. While there are many alternative therapies for the treatment of PBPS, the only approved oral medication is PPS (pentosan polysulfate sodium). As it has been associated with retinal toxicity after its widespread use, this study aims to evaluate the relationship between PPS use and maculopathy. Material and Methods The patients diagnosed with PBPS between 2010 and 2020 who may only benefit from PPS use were included into the study after subgroup and phenotype assessment (urinary and non-ulcerative organspecific subgroups). In our study, patients who had history of degenerative maculopathy or diseases predisposing to maculopathy (age-related macular degeneration, diabetes mellitus, hypertension, chronic vascular disorders, central serous chorioretinopathy, retinal dystrophy, epiretinal membrane, and chronic exposure to hydroxychloroquine) were excluded to prevent possible misdirection. Patients underwent best-corrected visual acuity assessment using Snellen chart, anterior segment and fundus examination using slit lamp biomicroscopy, and intraocular pressure measurement. Color vision test (Ishihara test), posterior segment optical coherence examination and 10-2 visual field test were performed, and color images of the fundus and autofluorescence imaging were obtained. Best-corrected visual acuity, color vision results, macular, choroidal and mean retinal nerve fiber thicknesses, mean deviation of the visual field and fundus findings were recorded. Results Out of 15 patients included into the study, 4 (37.5%) were male and 11 (73.3%) were female. The mean age of the patients was 53.3±11.2 years. During the follow-up, the duration of oral PPS use was found to be 33.01±10.59 months, cumulative oral PPS dose to be 216.02±97.63 g and duration of diagnosis to be 66.64±39.37 months. The mean central macular thickness of the patients was measured to be 254.55±33.11 μm, and the mean choroidal thickness to be 261.82±34.22 μm. Mean deviation of the visual field of the patients was found to be -1.89 ±-1.25 dB. The mean retinal nerve fiber thickness was measured to be 98.1±17.62 μm from the fundus autofluorescence images of the patients. Furthermore, in the present study, the ocular findings of the patients who are at below and above the mean cumulative dose and exposure period were compared. Conclusion This study detected no correlation between longterm PPS use and maculopathy. When forming the patient group; it is crucial to exclude patients with comorbidities such as diabetes mellitus and hypertension, and to form a homogeneous group by phenotype and subgroup assessment. Randomized, prospective, multi-center studies are needed to better assess this correlation.

PENTOSAN POLİSÜLFAT SODYUM TEDAVİSİ ALAN PRİMER MESANE AĞRISI SENDROMU HASTALARINDA PİGMENTER MAKULOPATİ İLİŞKİSİNİN DEĞERLENDİRİLMESİ

Amaç Primer mesane ağrı sendromu (PMAS); suprapubik bölgede ağrı, sık idrara çıkma, ani sıkışma hissi ve nokturi gibi alt üriner sistem semptomlarının en az birinin 6 haftadan uzun bir süre eşlik etmesi olarak tanımlanmaktadır. Primer mesane ağrı sendromu tedavisinde birçok alternatif tedavi olmasına rağmen oral olarak onaylanan tek ilaç pentosan polisülfat sodyumdur (PPS). Yaygın kullanımı sonrasında retinal toksiteyle ilişkilendirilmesinden dolayı çalışmamızda PPS kullanımı ile makulopati arasındaki ilişkiyi değerlendirmeyi amaçladık. Gereç ve Yöntem 2010-2020 yılları arasında tek merkezli PMAS tanısı alıp sadece PPS kullanımından fayda görebilecek alt grup ve fenotip değerlendirmesi (üriner ve non-ülseratif organa özgü alt gruplar) sonucunda çalışmaya dahil edildi. Çalışmadan özgeçmişinde dejeneratif makulopatisi olan veya makulopatiye yatkınlık yaratan hastalıkları olanlar çalışmadan çıkarılmışlardır. Hastalara Snellen görme eşeli ile düzeltilmiş en iyi görme keskinliği ölçümü, slit lamp biyomikroskop ile ön segment ve fundus incelemesi yapıldı ve göz içi basınçları ölçüldü. Renkli görme testi, arka segment optik koherans incelemesi ve10-2 görme alanı testi uygulandı ve fundus renkli ve otofloresans fotoğrafları çekildi. Düzeltilmiş en iyi görme keskinliği, renkli görme sonuçları, makula, koroid ve ortalama retina sinir lifi kalınlıkları, görme alanı ortalama sapma değeri ve fundus bulguları kaydedildi. Bulgular Çalışmaya dahil edilen toplam 15 hastanın 4’ü (%37,5) erkek, 11’i (%73,3) kadındı. Hastaların yaş ortalamaları 53,3±11,2 olarak gözlendi. Takipleri sırasında ortalama oral PPS kullanım süresi 33,01±10,59 ay ve kümülatif oral PPS dozu 216,02±97,63 gr tanı süreleri ise 66,64±39,37 ay olarak tespit edilmiştir. Hastaların ortalama merkezi makula ve koroid kalınlığı sırasıyla 254,55±33,11 mikron, 261,82±34,22 mikron olarak ölçüldü. Hastaların görme alanı sapma değeri ortalaması-1,89±-1,25 dB, fundus-otofloresans görüntülerinde ortalama retina sinir lif kalınlığı ise 98,1±17,62 mikron ölçüldü. Ek olarak çalışmamızda ortalama kümülatif dozun ve maruziyet süresinin altında ve üstündeki hastaların da göz bulguları kendi içinde karşılaştırıldı. Sonuç Çalışmamızda kronik PPS kullanımı ile makulopati arasında bir ilişki saptanmamıştır. Hasta grubunun oluşturulmasında; diyabet ve hipertansiyon gibi ek hastalıkları olan hastaların çıkartılması, fenotip ve alt grup değerlendirmesi sonucunda homojen bir şekilde oluşturulması son derece önemlidir.

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