Effect Of Topical Losartan In A Case Of Corneal Thermal Injury.

To report the effect of topical losartan eyedrops in a case of subepithelial fibrosis post thermal injury by fireworks through a serie of anterior segment OCT scans. 

This case was managed in the clinic of the department of pediatric ophthalmology, Abu El Rish hospital Cairo university, Kasr El Eini.

A 4 year old child was referred to our clinic with unilateral corneal edema following ocular trauma by fireworks. Initial examination revealed a best-corrected visual acuity (BCVA) of 6/6 in the right eye (OD) and 1/60 in the left eye (OS). Slitlamp biomicroscopy of OS showed diffuse corneal edema with epithelial irregularities but without epithelial defects or limbal stem cell deficiency. Anterior segment optical coherence tomography (AS-OCT) revealed a central corneal thickness (CCT) of 851 µm with midstromal opacities.

The patient was started on topical difluprednate 0.05% 4 times daily and hypertonic saline 5% 4 times daily to reduce corneal edema and inflammation. Upon follow-ups, BCVA improved to 6/60, AS-OCT showed a reduction in CCT to 450 µm, but areas of subepithelial fibrosis measuring approximately 70 µm in thickness persisted. Given the potential for TGF-β signaling inhibition in reducing myofibroblast survival, a trial of topical losartan (0.8 mg/mL) was initiated 6 times daily for 3 months.

The patient was monitored with slit-lamp examinations, VA assessments & AS-OCT imaging. One month after initiating topical losartan, AS-OCT revealed corrugation of the subepithelial fibrosis. Subsequent follow-up showed progressive thinning and decreased density of the fibrotic tissue, which correlated with improved corneal clarity on slit-lamp examination. After three months, the patient’s VA improved to 6/24 & treatment was then tapered waiting  for further assessment .

Topical losartan is effective in reducing corneal suepithelial fibrosis after thermal traumatic injuries.

It's a novel approach to prevent fibrotic corneal scarring, in our case it offered a potential alternative to anterior lamellar keratoplasty. But still further studies are needed to validate its efficacy.