■介绍使用金刚烷胺10年后发生不可逆角膜水肿的情况。进行了文献综述,以描述金刚烷胺引起的角膜水肿的临床特征和结果。
一名36岁女性,有6周的逐渐进行性双侧无痛性视力丧失的病史,右眼和左眼视力(VA)分别为20/350和20/300,分别。检查显示双侧弥漫性中央角膜水肿伴多处Descemet膜皱褶,无内皮素,角膜沉淀或眼内炎症。这对高渗盐水滴剂和口服阿昔洛韦对假定的疱疹性内皮炎的经验性治疗没有反应。药物审查显示,在过去的10年中,每天使用金刚烷胺100mg,她的神经科医生为疲劳开的处方.尽管停止了金刚烷胺,角膜水肿是不可逆的,因为内皮细胞计数明显降低,分别为625个(右)和680个细胞/mm2(左)。
■该病例强调需要将金刚烷胺视为原因不明的双侧非牙本质角膜水肿的原因。对33例病例报告的文献回顾显示,金刚烷胺诱导的角膜水肿的特征大致相似;而大多数病例具有良好的结局,中位VA20/25(四分位距IQR20/20-20/30),并且在金刚烷胺停药后30天内(IQR14-35)角膜水肿完全消退,最多经历低内皮细胞密度759个细胞/mm2(IQR621-1078)。一起来看,对于可能长期需要金刚烷胺的人,应考虑进行镜面显微镜检查。
UNASSIGNED: 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.
UNASSIGNED: 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/mm2 (left).
UNASSIGNED: 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/mm2 (IQR 621-1078). Taken together, screening specular microscopy ought to be considered for those in whom amantadine is likely required long-term.