Corneal Endothelial Toxicity Following Over-Dosed Concentrated Topical Nepafenac: A Case Report

To report an unusual and extensive corneal endothelial toxicity due to over-dosed high concentration topical NSAIDS (Nepafenac 0.3% eye drops QID) in a post cataract surgery.

A case report from the department of Cataract services, at a Tertiary Eye Care Institution in S.India

A 58 year old female developed severe corneal edema due to endotheliitis on 3rd POD (phacoemulsification) with reduced post-op vision from 20/20 to CF.

She underwent uneventful cataract surgery LE with improved vision of 20/20 till 3^rd POD . Post operative medications prescribed were fixed combination Moxifloxacin 0.5% with Dexamethasone 0.1% QID and topical 0.3% nepafenac suspension OD .On 3^rd POD presented with severe corneal edema, pain with vision of CF at 2M, immediately following an application of Nepafenac 0.3% eye drops  and was diagnosed as endothelial toxicity due to high concentration topical nepafenac (0.3%) which she was using 4 times a day, instead of advised once daily dosing. Had a non-resolving corneal edema & underwent endothelial keratoplasty 3 months post cataract. Topical NSAIDs are known to cause several ocular surface and corneal toxicities, perhaps this is the first case of endothelium compromise of its over-dosed concentrated forms.

This case is reported to emphasize the rational use of high concentration topical NSAIDS by cataract surgeons.

Patients need a thorough counselling on routine post operative medications, on its dosage and possible drug toxicities after cataract surgery, to avoid such disastrous complications, even though very rare & unusual.