Cytarabine-Induced Corneal Toxicity: Clinical Features and Relief of Symptoms with Loteprednol Etabonate 0.5% in Two Patients

Abstract

We report two patients who developed toxic keratopathy following high-dose cytarabine chemotherapy and whose symptoms resolved following topical loteprednol etabonate 0.5% treatment. A 25-year-old woman and a 26-year-old man with acute myeloid leukemia were referred to our department with symptoms of ocular discomfort, photophobia, and blurred vision after consolidation chemotherapy. Central corneal epithelial microcysts were observed bilaterally in both patients, and in vivo confocal microscopy showed highly reflective disseminated granular and irregular intraepithelial opacities, mainly in the basal epithelial layers. Loteprednol etabonate 0.5% relieved both patients’ symptoms in less than a week, and the microcysts disappeared in 2 to 3 weeks of treatment. Although there is no standardized treatment protocol for cytarabine-induced corneal toxicity, dexamethasone 0.1% and prednisolone phosphate 1.0% were reported to be effective in the resolution of discomfort and symptoms. In the two patients we report herein, loteprednol etabonate 0.5% four times daily was also effective in suppressing the symptoms.

Drug-induced corneal deposits: an up-to-date review

“…As shown in a prospective confocal microscopy study of 11 patients treated with cytarabine arabinosid, cytarabine causes necrosis of basal epithelial cells with a granular cytosolic signal; these necrotic cells migrate to the wing layer and ultimately to the apical epithelial layers over time 67. This leads to bilateral corneal changes beginning as numerous central reflective epithelial microcysts measuring 5–6 mm in diameter and disseminated reflective granular and irregular intraepithelial opacities mainly in the basal epithelial layers 68 69. Corneal opacities disappears within 4 weeks of drug cessation 66.…”

“… 70 The application of topical loteprednol etabonate 0.5% four times daily was recently shown to help relieve the symptoms within 1 week and disappearance of corneal changes after 2–3 weeks. 69 …”

“…Treatment with topical dexamethasone may help symptoms resolve within a few days and the disappearance of corneal microcysts within 1 week 70. The application of topical loteprednol etabonate 0.5% four times daily was recently shown to help relieve the symptoms within 1 week and disappearance of corneal changes after 2–3 weeks 69…”

Ocular Complications of Antineoplastic Therapies

“…After high-dose therapy, concentration of cytosine arabinoside was found to be high in CSF, tears, and aqueous humor which may play a role in toxicity [ 24 ]. Özcan et al found that administering topical loteprednol etabonate 0.5% helped alleviate toxic keratopathy that arises from high dose cyctosine arabinoside treatment [ 25 ].…”