A Case of Irreversible Corneal Endothelial Damage Associated with Amantadine Use

Abstract

Purpose: To report a case of irreversible corneal endothelial cell damage associated with amantadine administration.Case summary: A 60-year-old female patient was referred with bilateral painless corneal edema. There was no history of ocular trauma or surgery. The was no sign of ocular surface inflammation, such as, conjunctival injection, either. At presentation, her best corrected visual acuity (BCVA) was 20/100 in the right eye and 20/50 in the left eye. Review of the past medical history revealed that she had been diagnosed with Parkinson’s disease and had been taking amantadine (100 mg, twice a day) for 3 years. At 7 weeks after cessation of amantadine, corneal edema was resolved bilaterally and BCVA improved to 20/30 in the right eye and 20/20 in the left eye. However, specular microscopy showed low endothelial cell density (ECD) with 886 ± 297/mm2 in the right eye and 926 ± 374/mm2 in the left eye. At 4 months after cessation, there was no corneal edema and BCVA was 20/25 in the right eye and 20/20 in the left eye. However, ECD was low with 852 ± 249/mm2 in the right eye and 903 ± 332/mm2 in the left eye.Conclusions: In cases with bilateral corneal edema without no obvious pathology, the history of medication, such as, amantadine, should be reviewed. Although cessation of amantadine can lead to improvement of corneal edema, irreversible damage of the corneal endothelial cells may remain. Serial evaluation of corneal endothelial cells is therefore recommended in patients with systemic amantadine administration.