A CASE OF CORNEAL HAZE AFTER PHOTOREFRACTIVE KERATECTOMY (PRK) MANAGED WITH TOPICAL LOSARTAN

Losartan is an angiotensin II receptor blocker (ARB) initially developed as an antihypertensive agent that also modulates transforming growth factor-β (TGF-β), a driver of corneal fibrosis. Preclinical studies and early clinical experience suggest that topical losartan may have anti-fibrotic effects. We report a case of grade 2 post-PRK corneal haze managed with topical dexamethasone and losartan drops.

IRIS Ophthalmology Centre, Nicosia, Cyprus.

A 36-year-old man developed right-eye haze 5 months after PRK. Initial management consisted of dexamethasone 1 mg/mL, administered four times daily for 1 month. Due to persistent symptomatic haze, losartan 0.8 mg/mL was added six times daily with ongoing dexamethasone for 5 months. Visual acuity (VA), slit-lamp findings, corneal topography, and patient-reported symptoms were regularly monitored.

Following PRK, uncorrected VA was 6/6 but declined to 6/9 with grade 2 haze by 5 months. After 1 month of dexamethasone monotherapy, VA remained 6/9 with persistent haze and symptoms of glare and halos. Following 5 months of combined therapy, vision improved by two lines, returning to 6/6. Corneal topography demonstrated decreased anterior elevation and reduced irregular astigmatism within the central 3-mm zone. Slit lamp examination showed partial resolution of corneal haze, improving from grade 2 to grade 1. The patient reported reduced glare and halos. No adverse effects were noted.

Topical losartan with dexamethasone was associated with partial resolution of post-PRK corneal haze and symptomatic improvement. Although the independent contribution of losartan cannot be clearly determined due to concomitant treatment, this case contributes valuable data to the limited existing literature. It further supports the need for prospective controlled trials to evaluate the efficacy and long-term safety of topical losartan for corneal fibrosis.