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

Yıl 2022, Cilt: 29 Sayı: 1, 59 - 65, 01.03.2022

Çağrı Doğan , Arzu Malak , Murat Akgül , Cenk Murat Yazıcı , Ayşe Sarıfakıoğlu , Tansu Gönen , Hulusi Dayısoylu , Ece Karasu Günder

https://doi.org/10.17343/sdutfd.983094

Öz

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.

Anahtar Kelimeler

Tedavi, Pentosan Polisülfat Sodyum, Pigmenter Makulopati, Primer Mesane Ağrı Sendromu, Yan Etki

Destekleyen Kurum

Yok

Proje Numarası

yok

Teşekkür

Çalışmamızda yer alan katılımcılar ve yardımcı sağlık personeline teşekkür ederiz.

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

Öz

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.

Anahtar Kelimeler

Pentosan Polysulfate Sodium, Pigmentary Maculopathy, Primary Bladder Pain Syndrome, Side Effects, Treatments

Proje Numarası

yok

Kaynakça

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