Longitudinal Corneal Densitometric Changes After Topical 0.8% Losartan In Traumatic And Postinfectious Corneal Scars: A 6-Month Follow-Up Study

Losartan is known to inhibit stromal myofibroblast differentiation and thereby reduce corneal fibrosis and haze formation after injury. Based on this antifibrotic mechanism, we aimed to quantitatively evaluate the effect of 0.8% topical losartan on scar density as well as keratometric and pachymetric parameters in patients with a history of penetrating corneal injury, microbial keratitis, or foreign body–related corneal opacities.

In this retrospective study, patients aged ≥18 years with penetrating corneal injury repair, prior microbial keratitis, or corneal foreign body injury treated with topical 0.8% losartan were included. Topical losartan initiation (4×1) timepoint was defined as baseline; follow-up was at 30±5, 60±10, 90±10, and 180±20 days. On Scheimpflug imaging, the axial section with the largest baseline scar and two adjacent sections. Raw pixel values were used to calculate anterior, mid, posterior one-third and whole-cornea densitometry using a custom Python script. Longitudinal changes in densitometric, pachymetric and keratometric (Kmax) variables were analyzed with linear mixed-effects models with opacity duration as covariate.

Thirty-five patients aged 18–70 years were included, comprising 14 with penetrating injuries, 14 with microbial keratitis, and 7 with corneal foreign body injuries. In the overall cohort, anterior one-third corneal densitometry showed a decreasing trend across visits, approaching significance (p = 0.055), mainly between baseline and 6 months. Subgroup analyses demonstrated a nonsignificant progressive decrease in penetrating injury and microbial keratitis, whereas foreign body injuries remained stable. Mid and posterior layers were stable across groups. Opacity duration was not associated with densitometric change. Pachymetry showed a nonsignificant reduction trend only in foreign body injuries while no trend was observed in Kmax.

Topical 0.8% losartan was associated with a reduction in anterior corneal densitometry, indicating a predominantly anterior stromal effect. Mid and posterior layers remained stable. The response was limited in post–foreign body scars, suggesting etiology-dependent variability. Keratometric parameters showed no meaningful change, and pachymetry remained largely stable, except for a mild reduction trend in foreign body–related scars. Overall, losartan appears to exert a modest, layer-specific effect primarily confined to the anterior cornea.