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NSAID-induced corneal melts
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 Corneal melt from generic ketorolac use. |
In 1999, corneal melts were reported by ASCRS members in a survey, and a connection to NSAIDs, particularly generic NSAIDs, was discovered. Although rare, this problem still exists today.
Corneal melting is a progressive and dissolving loss of stromal tissue that can be multifactorial and associated with a range of risk factors. NSAIDs can induce the production of matrix metalloproteinases and collagenases, which can go on to break down stromal tissue in a relatively rapid manner. Patients can have complete melting and perforation within just a few days. In a published study, Dr. Allan Flach noted that coexisting factors, in combination with NSAIDs, were implicated in corneal melts. While all topical NSAIDs carry a small risk of corneal melting in at-risk patients, it seems like the generic NSAIDs have been implicated more often. Some experts note that the lack of testing for generic ophthalmic drugs is problematic and may be a cause for concern.
In the photo shown here, the patient had a beautifully performed cataract surgery at the county hospital by a resident ophthalmologist. The patient returned to the clinic a few weeks after surgery noting eye pain and a drop in visual acuity. The cornea had an area of melting that thinned the stroma by more than 100 µm. The generic ketorolac NSAID was stopped, and fortunately, within a short period of time, the eye recovered.
Of course, we must use all medications judiciously and carefully, with the treatment tailored to the specific patient. But in addition, should generic ophthalmic drugs be required to undergo the same level of testing as brand name medications?
Reference:
Flach AJ. Corneal melts associated with topically applied nonsteroidal anti-inflammatory drugs. Trans Am Ophthalmol Soc. 2001;99:205-210; discussion 210-212.