Retrospective analysis of clinical features and management for drug-induced keratopathy

Abstract

Background In recent years,incidence of drug-induced keratopathy is increasing highly.Druginduced keratopathy is lack of typical clinical features and offen confused with the primary disease.Therefore,summarizing and concluding the clinicals feature and standard treatments of drug-induced keratopathy are key problem need to be solved urgently for us.Objective This study was to retrospectively analyze the clinical features and therapeutic procedure of drug-induced keratopathy.Methods A retrospective case series analysis method was adopted.The clinical data of 36 eyes (31 patients) with drug-induced keratopathy were collected by Shandong Eye Hospital from 2008 to 2012,including eye disease history,medication history,medication dosage and duration.A series of relevant examinations were performed,including best corrected visual acuity (BCVA) before and 1 month after treatment,Schirmer test Ⅰ (S Ⅰ t),tear film break-up time (BUT),meibomian gland findings,the location of the keratopathy,the characteristics of keratophthy before and after fluorescein staining.The treating were given,including cessating of the original drugs,applying corneal repair promotion and anti-inflammatory drugs as well as the comprehensive treatment for meibomian gland embolization and dry eye,such as the hot packs and massage in the eyes with meibomian gland dysfunction and a tear dot embolization therapy in the eyes with S Ⅰ t ＜ 5 mm and BUT＜5 s.Paired t test and repeated measured one-way analysis of variance in SPSS 17.0 software were used to compare the BCVA,BUT and S Ⅰ t outcomes.The correlation between corneal repair duration and S Ⅰ t results was analyzed by Pearson linear correlation analysis.Results The primary cause of drug-induced keratopathy was irrational use of drugs,including antiviral drugs,antibiotics,hormone,antiallergic,lowering-intraocular pressure drugs,turn for 23 eyes,12 eyes,10 eyes,1 eye and 1 eye,respectively.Improper route of administration included 25 cases of overuse of eye drops and 6 cases of subconjunctival injection.BCVA was 0.69 ± 0.28 1 month after treatment,which was significantly improved in comparison with before treatment (0.32 ± 0.26) (t =11.02,P ＜ 0.01).Clinical manifestations included corneal epithelial diffusive and point-like roughness,corneal epithelial defect and even corneal ulcer for severe cases,corneal edema,Descemet membrane folds and partially visible corneal filiform.Drug-induced keratophthy was mainly located in the central and lower cornea.Comprehensive therapy was effective with the treating duration about 1 week to 8 weeks.A negative correlation was found between the corneal restore duration and S Ⅰ t results (r =-0.835,P＜0.01).Conclusions Corneal changes secondary to topical medications may affect all layers of the cornea.Clinicians should be mindful of drug-induced ocular disorders.The early diagnosis of druginduced keratopahthy depends on the medical history and clinical features.A comprehensive treating based on ocular surface conditions is available. Key words: Drug-related side effect and adverse reaction; Corneal disease/chemically induced ; Epithelium,corneal/pathology ; Endothelium, corneal/ pathology ; Ocular surface/disease ; Visual acuity