PICTURES & PERSPECTIVES: Large Subfoveal Vitelliform Lesions
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Pentosan polysulfate (Elmiron; Janssen, Horsham, PA) toxicity is typically characterized by centrifugally spreading coarse macular and parapapillary retinal pigment epithelium alterations, reticular lipofuscin accumulation, and rarely small vitelliform lesions. It may be confused with or overlap pattern dystrophy and age-related macular degeneration.

A 65-year-old woman was administered 200 mg of pentosan polysulfate twice daily for 15 years for interstitial cystitis presented with large, subfoveal, hyperautofluorescent vitelliform lesions (Fig A, B), elongated photoreceptor outer segments (Fig C, D), and intraretinal hyperreflectivities on OCT. Genetic testing revealed a variant of unknown significance in ABCA4, but it is unclear what role this played in lipofuscin accumulation.

Source:https://www.aaojournal.org/article/S0161-6420(20)30736-3/fulltext
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