A case of bilateral deep stromal corneal opacity and vascularization after use of multiple antiglaucoma medications including brimonidine tartrate ophthalmic solution

Tsujinaka, Aika; Takai, Yasuyuki; Inoue, Yoshitsugu; Tanito, Masaki

doi:10.1111/aos.14008

Cited by 8 publications

(4 citation statements)

References 4 publications

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“…In 2017, Maruyama et al [3] reported two cases of peripheral corneal opacity that developed after treatment with BT. To date, four reports including eight cases have been described in Japan [3][4][5][6]. In this study, we report a case of bilateral corneal stromal opacity, which showed several similarities to previous cases treated with BT that presumably developed after treatment with topical antiglaucoma medications other than BT.…”

Section: Introductionsupporting

confidence: 56%

“…BT has been associated with ocular side effects including conjunctival injection, allergic conjunctivitis, and blepharitis; however, corneal side effects are uncommon [1,2]. To date, four reports including eight cases with severe corneal disorder have been reported in Japan [3][4][5][6]. According to these reports, the clinical features of BT-induced corneal opacity were as follows.…”

Section: Discussionmentioning

confidence: 99%

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Corneal Opacity Induced by Antiglaucoma Agents Other Than Brimonidine Tartrate

Kasuya

Sano

Makino

et al. 2020

Case Reports in Ophthalmological Medicine

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The aim of this study is to report a patient with corneal opacity that developed after the use of topical antiglaucoma medications other than brimonidine tartrate (BT). An 85-year-old woman presented with corneal opacity and neovascularization in both eyes. A diagnosis of glaucoma was made 20 years previously, and antiglaucoma agents were prescribed (latanoprost, tafluprost, timolol maleate, travoprost, bimatoprost, ripasudil hydrochloride hydrate, and brinzolamide/timolol maleate) for both eyes. Ocular examination revealed semicircular fan-shaped corneal sterile infiltration with neovascularization. Anterior-segment optical coherence tomography (OCT) showed marked corneal opacity and thickened corneal stroma. The topical drugs were discontinued and replaced with 0.1% betamethasone eye drops. Two weeks after topical drugs were discontinued and replaced with betamethasone, the corneal sterile infiltration markedly improved, although the corneal opacity remained across the stromal layer. In addition, corneal opacity, intermixed with separate transparent sections, was observed as a striped shape. OCT showed an improvement of the thickened corneal stroma. Six weeks after the initial visit, the remaining corneal opacity could be seen as a mixture of opaque and nonopaque areas in stripes. The corneal stromal thickness decreased almost back to the normal range, while the area of the corneal opacity remained unchanged. In vivo laser confocal microscopy showed hyperreflective materials with needle-like structures in the corneal stroma. The corneal opacity showed several similarities to the previous reports of the cases treated with BT. Therefore, clinicians should be mindful of a possible development of corneal opacity in patients treated with antiglaucoma medications other than BT.

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Section: Introductionsupporting

confidence: 56%

Section: Discussionmentioning

confidence: 99%

Corneal Opacity Induced by Antiglaucoma Agents Other Than Brimonidine Tartrate

Kasuya

Sano

Makino

et al. 2020

Case Reports in Ophthalmological Medicine

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“…While the mechanism of LK development in patients treated with BT is unclear, it is thought to be due to an allergic reaction to some form of antigen present in BT, given the resolution with steroids, or a reaction related to preservatives such as benzalkonium and sodium chlorite found in BT [ 7 , 8 ].…”

Section: Discussionmentioning

confidence: 99%

“…Various drugs have been implicated in formation of LK including brimonidine tartrate (BT), a topical ocular hypotensive agent. A summary of reported cases involving LK and BT use is shown in Table 1 [5][6][7]. Common ocular side effects of BT include blepharitis, allergic conjunctivitis, and conjunctival injection, while corneal complications are less common [8].…”

Section: Discussionmentioning

confidence: 99%

Bilateral Lipid Keratopathy in the Setting of Brimonidine Tartrate Use

Moshirfar

Ziari

Payne

et al. 2023

Case Reports in Ophthalmological Medicine

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Lipid keratopathy (LK) is a rare disease involving lipid deposition in the cornea resulting in corneal opacification. Primary LK can arise sporadically while secondary LK is seen in patients with a history of ocular trauma, medication exposure, infection, inflammation, or disorders resulting in derangements of lipid metabolism. Secondary LK is more common and occurs due to neovascularization. Use of precipitating medications should be considered in LK workup, particularly for patients in whom other etiologies have been ruled out. Brimonidine, an ocular hypotensive medication, can be associated with LK. We present a case of bilateral secondary LK in a patient with a history of prolonged brimonidine use, without additional contributing factors.

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Antiglaucomas/betamethasone

2019

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A case of bilateral deep stromal corneal opacity and vascularization after use of multiple antiglaucoma medications including brimonidine tartrate ophthalmic solution

Cited by 8 publications

References 4 publications

Corneal Opacity Induced by Antiglaucoma Agents Other Than Brimonidine Tartrate

Corneal Opacity Induced by Antiglaucoma Agents Other Than Brimonidine Tartrate

Bilateral Lipid Keratopathy in the Setting of Brimonidine Tartrate Use

Antiglaucomas/betamethasone

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