Bevazizumab And Tacrolimus Eye Drops In The Treatment Of Bilateral Lipoid Keratopathy In A Pediatric Patient

To remember the clinical characteristics of lipoid keratopathy, its pathogenesis, as well as the different therapeutic possibilities.

 

A case of a pediatric patient with bilateral lipoid keratopathy is presented.

During the follow-up, serial iconography, ophthalmologic examination with slit lamp (LH), fundoscopy, analysis with lipid profile, genetic study and corneal topography study with pentacam topographer were performed.

13-year-old patient with a history of hyperopia and strabismus.

He presents symptoms of photophobia and ocular irritation of years of evolution. He is referred to our practice for the appearance of a white lesion on the cornea of both eyes.

The best corrected visual acuity is 0.5 and 0.9.

In the slit lamp examination, stromal deposits of feathery appearance and predescematic polychromatic (symmetrical mirror image) are observed in the cornea of both eyes at the inferior temporal level, together with an important active neovascularization.

Laboratory tests with lipid profile are within normal limits.

Family members are questioned, ruling out the existence of similar clinical pictures.

The patient is awaiting the results of the genetic study.

Treatment  is performed with 1% cyclosporine eye drops and then tacrolimus ointment every 12 hours. She presented sporadic episodes of increased hyperemia and corneal vascularization requiring rescue treatment with topical corticosteroids. Bevacizumab conjunctival injection in the right eye is performed punctually.

Subsequently, bevacizumab eye drops are added 1 drop every 8 hours.

With this treatment there was clinical improvement with less active corneal vascularization, but a circumferential progression of lipid deposition was observed in both eyes, more pronounced in the right eye which, for the moment, respects the visual axis.

 

 

Lipoid keratopathy is a rare entity of uncertain etiology.

The bilateral and symmetrical presentation and the absence of alterations in lipid metabolism may lead us to suspect a primary form

One of the hypotheses points to an alteration of the keratocyte itself  with necrosis of the keratocyte leading to inflammation and vascularization.

Different procedures have been used to reduce corneal vascularization: topical corticosteroids or  antiangiogenic, argon laser photocoagulation and fine needle diathermy; all of them with limited effect.

In our patient, topical treatment with tacrolimus and bevacizumab eye drops partially controlled the episodes of photophobia and ocular redness. However, the disease has progressed in both eyes.