Maculopathy after long-term use of fondaparinux, a heparin mimetic and heparanase inhibitor

Fondaparinux is structurally and functionally related to PPS, which is also a heparin mimetic and heparanase inhibitor. Both drugs are now associated with phenotypically similar disruptions of the macular retinal pigment epitheliopathy. Although used for different clinical indications, both fondaparinux and PPS are sulfated oligosaccharides related to heparin that bind and inhibit heparanase, a critical enzyme in the extracellular matrix. This case is relevant for research into pharmacologic uses of heparanase inhibitors and monitoring for retinal disease in patients treated with them.