Topical Losartan As A Novel Therapeutic Approach For Corneal Scars: Clinical Outcomes From A Case Series

To report the outcomes of six patients diagnosed with clinically significant corneal fibrosis caused by refractive surgery or viral keratitis who underwent treatment with topical Losartan 0.8mg/mL. 

Corneal fibrosis is a significant complication associated with corneal injuries, such as complex surgeries and infections, leading to decreased transparency and vision loss. Current therapeutic options are limited to primarily surgical interventions. Recent studies have highlighted the role of transforming growth factor β (TGF-β) in the fibrotic processes underlying corneal haze, positioning Losartan as a potential therapeutic agent due to its inhibitory effects on TGF-β signalling molecule ERK.

This case series investigated the efficacy of topical losartan in treating corneal scars in patients with varying clinical backgrounds and etiologies. Six patients diagnosed with corneal scars resulting from herpetic keratitis or complicated photorefractive keratectomy (PRK) were treated with topical losartan at a concentration of 0.8 mg/mL. Each patient underwent comprehensive ophthalmologic evaluations, including anterior segment optical coherence tomography (OCT) and corneal tomography, to assess clinical outcomes after treatment. 

Improvement in visual acuity was noted in five out of six patients. Patient-reported outcomes and imaging demonstrated significant reductions in corneal scars and enhanced transparency following treatment. However, one patient continued to have stable visual acuity despite a decrease in opacity after seven months of therapy. 

This series highlights the potential of topical losartan as a novel approach for managing corneal scars by targeting the TGF-β signalling pathway. With corroborative imaging assessments indicating measurable improvements, losartan presents a promising adjunctive therapy for corneal scarring. Vehicle-controlled clinical trials are warranted to establish its long-term efficacy and safety across diverse populations and clinical settings.