J Korean Ophthalmol Soc.  2009 Jun;50(6):936-941. 10.3341/jkos.2009.50.6.936.

A Case of Amantadine-Induced Corneal Edema

• Hwang BS
• Lee SB
• Cha SC
• Wee WR

• KMID: 2212374
• DOI: http://doi.org/10.3341/jkos.2009.50.6.936

Abstract

PURPOSE: To report a rare case of corneal edema caused by amantadine.
CASE SUMMARY
A 35-year-old man was diagnosed with hypoxic brain damage caused by ventricular fibrillation. The patient showed Parkinsonism and was started on treatment with amantadine. Thirty-seven months after the commencement of amantadine treatment, the patient suffered a corneal ulcer in his right eye, which healed with opacity and thinning after medical treatment. After healing, slit-lamp examination revealed a bilateral, epithelial and stromal edema without obvious guttae and keratic precipitates. The corneal edema did not improve with topical treatment of 5% NaCl and 0.02% fluorometholone in both eyes. Three months after leaving the hospital, the patient's corrected visual acuity decreased to 0.2 (-2.0 Dsph -0.5 Dcyl Ax 90) in the right eye and 0.4 (-0.75 Dsph -2.0 Dcyl Ax 90) in the left eye. Amantadine medication was discontinued after discussion with the patient's neurologist. At the 1-month follow-up, corneal examination revealed resolution of the epithelial and stromal edema in both eyes. Corrected visual acuity was improved to 0.5 (-1.5 Dsph) in the right eye and 0.7 (-1.0 Dsph -1.0 Dcyl Ax 90) in the left eye.
CONCLUSIONS
In cases of corneal edema without an obvious causative disease, the patient's systemic medication list must be reviewed and amantadine should be considered as a possible cause.

Keyword

Amantadine; Corneal edema; Corneal endothelium; Parkinsonism

MeSH Terms

Adult
Amantadine
Corneal Edema
Corneal Ulcer
Edema
Endothelium, Corneal
Eye
Fluorometholone
Follow-Up Studies
Humans
Hypoxia, Brain
Parkinsonian Disorders
Ventricular Fibrillation
Visual Acuity
Amantadine
Fluorometholone

Figure

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  Figure 1. At 15 days after discontinuation of amantadine medication, the patient showed central corneal opacity and thinning with decreased epithelial and stromal edema in the right eye, and mild epithelial and stromal edema with minimal Descemet's membrane folds in the left eye. Ultrasound pachymetry revealed a central corneal thickness of 581 μm in the right eye and 630 μm in the left eye.

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  Figure 2. Specular photomicrographs of both eyes showed marked enlargement of the corneal endothelium and decrease of the corneal endothelial cell density at 15 days after discontinuation of amantadine medication. Cell density, coefficient of variation, and frequency of hexagons are 863±563 cells/mm2, 0.480, and 48.0% in the right eye, and 919±490 cells/mm2, 0.450, and 49.0% in the left eye, respectively.

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  Figure 3. At 1 month after discontinuation of amantadine medication, the patient showed resolution of epithelial and stromal edema of the cornea in both eyes with only central opacity and thinning in the right eye. Ultrasound pachymetry revealed a central corneal thickness of 421 μm in the right eye and 495 μm in the left eye.

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  Figure 4. At 1 month after discontinuation of amantadine medication, cell density, coefficient of variation, and frequency of hexagons of specular photomicrographs are 876±537 cells/mm2, 0.470, and 49.0% in the right eye, and 788±529 cells/mm2, 0.410, and 46.0% in the left eye, respectively.

Reference

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