title: COTTON-WOOL SPOTS AFTER USE OF MACITENTAN FOR PULMONARY ARTERIAL HYPERTENSION.
abstract: OBJECTIVE
  To report a case of transient, bilateral cotton spots after initiation of macitentan, an endothelin receptor antagonist used for the treatment of pulmonary arterial hypertension.
  
  
  METHODS
  Case report.
  
  
  RESULTS
  A 76-year-old woman with WHO Class IIIb pulmonary arterial hypertension was referred for evaluation of bilateral cotton-wool spots 1 week after starting macitentan therapy. The patient was asymptomatic and visual acuity was 20/25 in each eye. Fluorescein angiography and optical coherence tomography were completed. Given lack of symptoms and alternative treatment options, the patient was observed closely. The cotton-wool spots resolved 8 weeks after presentation and visual acuity remained stable at 20/25. Throughout the observation period, average mean arterial pressure was within normal limits at 84.8.
  
  
  CONCLUSIONS
  In patients using endothelin receptor antagonists, medication side effect should be considered in the differential diagnosis of cotton-wool spots.
authors.affiliation: Retina Service, Wills Eye Hospital, Philadelphia, Pennsylvania.
authors.forename: Mohammed Ali
authors.initials: MA
authors.lastname: Khan
authors.forename: Allen C
authors.initials: AC
authors.lastname: Ho
authors.forename: Marc J
authors.initials: MJ
authors.lastname: Spirn
mesh_terms: D000368:Aged; D065130:Endothelin A Receptor Antagonists / Q000009:adverse effects*; D005260:Female; D006801:Humans; D006976:Hypertension, Pulmonary / Q000188:drug therapy*; D011743:Pyrimidines / Q000009:adverse effects*; D012164:Retinal Diseases / Q000139:chemically induced* / Q000000981:diagnostic imaging; D013449:Sulfonamides / Q000009:adverse effects*
chemical_list: D065130:Endothelin A Receptor Antagonists; D011743:Pyrimidines; D013449:Sulfonamides; C533860:macitentan