BILATERAL IRREVERSIBLE CORNEAL OEDEMA SECONDARY TO AMANTADINE TOXICITY IN A PATIENT WITH MULTIPLE SCLEROSIS
Published 2022 - 26th ESCRS Winter Meeting
Reference: P117 | Type: Abstracts | DOI: 10.82333/86vz-9a42
Authors: Zahra Ashena* 1 , Wessam Mina 1
1OPhthalmology,BHR University Hospital Trust,London,United Kingdom
Purpose
Ocular toxicity of some systemic medications is well recognised, hence regular ophthalmic examination is arranged for patients. With regards to Amantadine, the literature reports evolution of corneal oedema two months to a few years after starting this medicine, with spontaneous resolution of oedema in short term intake and irreversible oedema in long-term use. However, its toxicity is yet unknown to most ophthalmologists and neurologists. To highlight the drastic impact of this medicine on the cornea and consequently the vision of these patients we report a case of bilateral irreversible corneal oedema in a young patient with multiple sclerosis (MS).
Setting
Queen’s Hospital, London, United Kingdom
Methods
A 36-year-old wheelchair bound Caucasian female, known with MS and suspect neuromyelitis optica (NMO) presented to the eye casualty with bilateral gradual deterioration of vision over six weeks. Her past ophthalmic history showed a few episodes of optic neuritis, affecting both eyes in the past with final best corrected visual acuity (BCVA) of 0.65 LogMar in the right eye and 0.55 LogMar in the left eye. At presentation, BCVA was 1.25 LogMar in the right eye and 1.20 LogMar in the left eye with no improvement with pinhole. Examination showed bilateral diffuse corneal oedema with multiple Descemet folds and no evidence of endothelial guttata. Specular microscopy showed 625 and 680 cells/mm2 in the right and left eye with central corneal thickness of 835µ and 796µ respectively. The eyes were quiet with no anterior chamber activity and normal intraocular pressure. The corneal sensation was completely normal and there was no history of herpes simplex keratitis in the past. Review of her medications revealed that she has been on Amantadine 100mg capsules once a day to treat the MS-related fatigue symptoms for 10 years and literature review confirmed the adverse effect of this medicine on the corneal endothelial cells. Amantadine was discontinued and she was treated with topical sodium chloride 5% eye drops and Aciclovir 400mg tablets 5 times a day for 2 weeks as an empirical treatment for less likely diagnosis of herpetic keratitis.
Results
Her corneal oedema did not resolve three months after her first presentation. She is on the waiting list for endothelial keratoplasty after discussing the risks and benefits of the procedure in a phakic patient, in particular development of cataract.
Conclusion
Bilateral diffuse corneal oedema in the absence of any ocular inflammation should prompt reviewing systemic conditions and medications of the patient. Also, Amantadine, which is proved to have a toxic effect on corneal endothelial cells, should be used with caution and with regular ophthalmology visits and endothelial cell counts. Otherwise, its side effect could be drastic in this young group of patients, who are already visually and physically disable by MS.