Rapid corneal adrenochrome deposition from topical ibopamine in the setting of infectious keratitis

Bhosai, Satasuk Joy; Lin, Charles C.; Greene, Jonathan B.; Bloomer, Michele M.; Jeng, Bennie H.

doi:10.1038/eye.2012.217

Cited by 6 publications

References 5 publications

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2013

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Ibopamine Corneal adrenochrome deposition: case reportA 50-year-old man developed corneal adrenochrome deposition following ibopamine use for chronic ocular hypotony.The man was started on ibopamine 2% eye drops 3 times daily for chronic bilateral hypotony 3 months before undergoing penetrating keratoplasty in his left eye due to a failed endothelial graft. His intraocular pressure was increased from 5 to 7mm Hg preoperatively by the ibopamine. One week postoperatively, a peripheral corneal epithelial defect was noted, which persisted despite aggressive lubrication and tapering of his postoperative corticosteroid eye drops. A brown-pigmented deposition was observed within the margins of the epithelial defect in the nasal peripheral corneal graft 5 weeks postoperatively. The pigmentation formed a plaque overlying the cornea, extending diffusely into the anterior one-third of the cornea. It was excised and sent for culture and histopathology.The man was initiated on moxifloxacin for presumed infectious keratitis. Based on culture results, moxifloxacin was changed to cefazolin and gentamicin, and the infectious keratitis markedly improved. The superficial pigmented plaque was further debrided at follow-up visits, but the intrastromal component accumulated within the margins of his persistent epithelial defect. Histopathology showed pigmented acellular material that stained positive for melanin, but negative for iron. The ibopamine drops were withdrawn.Author comment: "[B]ased on our observations, patients using topical ibopamine eye drops should be carefully monitored for pigment deposition in the cornea, particularly in the presence of a compromised epithelial surface".Bhosai SJ, et al. Rapid corneal adrenochrome deposition from topical ibopamine in the setting of infectious keratitis.

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