Eye Clinic, Department of Neurosciences, Psychology, Pharmacology and Child Health, University of Florence, Largo Brambilla 3, 50134, Florence, Italy.
BMC Ophthalmol. 2022 May 10;22(1):211. doi: 10.1186/s12886-022-02410-1.
To report a case of a patient showing bilateral corneal opacities after amantadine chronic treatment for Parkinson's Disease (PD) and corneal edema associated with intra-epithelial and -endothelial depositions. After amantadine discontinuation a complete clinical remission with only a partial ultrastructural corneal recovery was reported.
We describe a 78-year-old man with non-medical-responding bilateral corneal edema in treatment with systemic Amantadine for PD. In vivo confocal Microscopy (IVCM) analysis revealed hyperreflective particles at the epithelial level and expanded hyperreflective keratocyte and a disarrangement of stromal lamellae; endothelial cells showed hyperreflective intracellular inclusions in central and in peripheral areas with central polymegatism and pleomorphism. After 1 and 6 months the amantadine discontinuation, the absence of bilateral corneal edema and opacities were noted at the slit lamp examination, associated with the disappearance of epithelial and stromal abnormalities, but the persistence of endothelial hyperreflective deposits with a pleomorphism and polymegatism worsening at the IVCM exam.
The evaluation of a patient's cornea 6 months after the discontinuation of systemic amantadine therapy showed a clinical complete remission, with a complete resolution of the bilateral corneal oedema. On the other hand, ultrastructurally, amantadine toxicity is a completely reversible phenomenon at the epithelial level; conversely IVCM showed persistent endothelial degradation.
报告一例患者在接受金刚烷胺慢性治疗帕金森病（PD）后出现双侧角膜混浊和角膜水肿，与上皮内和内皮内沉积物有关。停用金刚烷胺后，报告了完全临床缓解，仅出现部分超微结构角膜恢复。
我们描述了一位 78 岁男性，因 PD 接受全身金刚烷胺治疗而出现双侧非药物反应性角膜水肿。活体共聚焦显微镜（IVCM）分析显示上皮层存在高反射性颗粒，扩张的高反射性角膜细胞和基质层排列紊乱；内皮细胞在中央和周边区域显示出高反射性细胞内内含物，伴有中央多形性和多态性。停药 1 个月和 6 个月后，裂隙灯检查发现双侧角膜水肿和混浊消失，与上皮和基质异常的消失相关，但内皮高反射性沉积物的存在和多形性和多态性恶化在 IVCM 检查中仍然存在。
对系统停用金刚烷胺治疗 6 个月后的患者角膜进行评估，显示出完全的临床缓解，双侧角膜水肿完全消退。另一方面，超微结构显示金刚烷胺毒性在上皮层是完全可逆的现象；相反，IVCM 显示内皮退化持续存在。
