Topical 0.08% Losartan As Antifibrotic Therapy For Corneal Opacities: A Five-Case Series

This five-case series evaluates the effect of topical 0.08% losartan (six times daily for six months) on corneal opacities.  The etiology of the corneal opacities included: herpes (n=2), bacterial (n=2), and Acanthamoeba (n=1). We analyzed changes in mean corneal densitometry across the anterior, central, and total layers compared to baseline. Secondary objectives include the assessment of pre- and post-treatment visual acuity at 6 months, both quantitatively (decimal notation) and qualitatively (subjective assessment).

Cornea Unit, Department of Ophthalmology, Sant Joan de Déu University Hospital (Althaia Foundation), Manresa, Barcelona, Spain. Single-center study conducted between January 2025 and February 2026.

Observational, longitudinal, retrospective case series. Five adults (five eyes) with persistent corneal opacities, were treated with topical 0.08% losartan six times daily for 6 months. Primary outcome: corneal opacity quantified via Scheimpflug corneal densitometry (Pentacam®; anterior, central, and total). Secondary outcome: visual acuity quantified in decimal notation. Pre- and post-treatment data were compared.

Five patients (five eyes) with corneal leukomas were evaluated. All patients reported subjective improvement in visual quality and reduced photophobia. Notably, Patient 3 and Patient 4 achieved gains of 5 and 3 lines of visual acuity, respectively. Regarding corneal densitometry, 3 out of 5 patients demonstrated a quantitative improvement in transparency across all corneal layers. Divergent findings were observed in two cases (Patients 1 and 4), where subjective visual quality improved despite an increase in densitometry values. This suggests technical limitations of Scheimpflug-based densitometry (Pentacam ®) in assessing specific corneal structural changes.

• Topical losartan represents a promising treatment for corneal opacities where the use of corticosteroids is controversial, such as in cases of Acanthamoeba or herpes.
• The treatment consistently enhances patient-reported outcomes, particularly in reducing photophobia and improving perceived visual clarity.
• While 3 out of 5 patients showed total densitometric improvement, the universal enhancement in visual quality suggests that losartan may optimize the optical properties of the cornea even when traditional densitometry shows varied results.