Pentosan Polysulfate Maculopathy Following Subcutaneous Injections for Arthritis

The findings of this case series suggest that PPS retinal toxic effects can occur with subcutaneous administration alone, at much lower doses than typically occurs with oral administration, potentially due to 10-fold higher bioavailability. Early recognition of this toxic maculopathy with multimodal imaging is important to limit exposure to this drug and avoid incorrect treatments. Given progression of maculopathy even following cessation, caution is advised when using subcutaneous PPS.