Bilateral Cotton Wool Spots After Use of an Endothelin Receptor Antagonist

Ambrisentan (Letairis; Gilead Sciences, Foster City, CA) is an endothelin receptor antagonist approved by the U. S. Food and Drug Administration for the treatment of pulmonary arterial hypertension. The authors describe the occurrence of bilateral cotton wool spots soon after initiation of ambrisentan treatment in a 29-year-old woman. Fluorescein angiography, optical coherence tomography, and fundus autofluorescence were performed. After discontinuation of ambrisentan, the cotton wool spots resolved without recurrence. To the authors' knowledge, this is the first report of retinopathy in the form of cotton wool spots associated with the use of an endothelin receptor antagonist.