Raharja Antony, Mina Wessam, Ashena Zahra
Queen's Hospital, Barking, Havering and Redbridge University Hospitals NHS Trust, Romford, United Kingdom.
Am J Ophthalmol Case Rep. 2023 Jul 3;32:101881. doi: 10.1016/j.ajoc.2023.101881. eCollection 2023 Dec.
To present a case of irreversible corneal edema after 10 years of amantadine use. A literature review was carried out to describe the clinical characteristics and outcomes of amantadine-induced corneal edema.
A 36-year-old woman presented with a 6-week history of gradually progressive bilateral painless visual loss with visual acuity (VA) of 20/350 and 20/300 in the right and left eye, respectively. Examination showed bilateral diffuse central corneal edema with multiple Descemet membrane folds without endothelial guttata, keratic precipitates or intraocular inflammation. This did not respond to hypertonic saline drops and empirical treatment for presumed herpetic endotheliitis with oral acyclovir. Medication review revealed the use of amantadine 100mg daily for the past 10 years, prescribed by her neurologist for fatigue. Despite discontinuing amantadine, corneal edema was irreversible due to a markedly reduced endothelial cell count of 625 (right) and 680 cells/mm (left).
This case highlights the need to consider amantadine as a cause of unexplained bilateral non-guttae corneal edema. A literature review of 33 case reports revealed broadly similar features of amantadine-induced corneal edema; whilst most cases had favorable outcomes with median VA 20/25 (interquartile range IQR 20/20-20/30) and complete resolution of corneal edema within 30 days (IQR 14-35) of amantadine discontinuation, most experienced low endothelial cell density 759 cells/mm (IQR 621-1078). Taken together, screening specular microscopy ought to be considered for those in whom amantadine is likely required long-term.
报告一例使用金刚烷胺10年后出现不可逆性角膜水肿的病例。进行文献综述以描述金刚烷胺诱导的角膜水肿的临床特征和转归。
一名36岁女性，有6周逐渐进展的双侧无痛性视力丧失病史，右眼和左眼视力分别为20/350和20/300。检查发现双侧弥漫性中央角膜水肿，有多个后弹力层褶皱，无内皮滴、角膜后沉着物或眼内炎症。高渗盐滴眼液及口服阿昔洛韦对疑似疱疹性内皮炎的经验性治疗均无效。用药回顾显示，在过去10年里，她的神经科医生因疲劳为她开具了每日100mg金刚烷胺的处方。尽管停用了金刚烷胺，但由于内皮细胞计数显著减少，右眼为625个/mm²，左眼为680个/mm²，角膜水肿仍不可逆。
本病例强调了需将金刚烷胺视为不明原因双侧无滴状角膜水肿的病因。对纳入33例病例报告的文献综述显示，金刚烷胺诱导的角膜水肿具有大致相似的特征；虽然大多数病例预后良好，停用金刚烷胺后30天内（四分位间距IQR为14 - 35天）平均视力为20/25（IQR为20/20 - 20/30）且角膜水肿完全消退，但大多数病例的内皮细胞密度较低，为759个/mm²（IQR为621 - 1078）。综上所述，对于可能需要长期使用金刚烷胺的患者，应考虑进行内皮细胞镜检查。
