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Amantadine may cause endothelial loss
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WASHINGTON – Amantadine, which is used to treat influenza type A, Parkinson’s disease, muscle fatigue, muscle movement disorders and multiple sclerosis off-label, may cause corneal edema resulting from endothelial loss, according to a poster presented here at Optometry’s Meeting.
Based on her case report and subsequent research, Katrina Hrubiec, OD, told attendees here that they may want to consider getting a baseline corneal thickness before their patients begin treatment with this agent.
Hrubiec said she saw a 61-year-old man for an annual exam at a Veterans Administration facility in Maine during her 4th year rotation. He reported blurry vision at distance and reading. Best corrected visual acuity was 20/30 OD and 20/70 OS, with anisocoria previously noted. Central corneal thicknesses were 637 µm OD and 837 µm OS. He had 1+ Descemet’s folds and 1+ guttate in the right eye and 3+ central Descemet’s folds and 1+ guttate in the left eye.
“A review of active medications showed an association between amantadine use and corneal edema; this appeared to be the probable cause,” Hrubiec said in her poster abstract.
“We talked to the patient’s doctor and got permission to stop the amantadine,” she told meeting attendees. “After 1 month vision was 20/20, the cornea was clear, and corneal thickness was normal. Three months later he came in for follow-up. He had a little bit of increased weakness, but there was no mention of restarting amantadine.”
Hrubiec referred to previous case reports where corneal edema was first treated with anti-inflammatories then surgeries, such as full corneal transplant or Descemet’s stripping automated endothelial keratoplasty.
“Because it’s due to possible endothelial loss, a lot of doctors may think it’s due to Fuchs’,” she said, and “the edema may come back because they didn’t stop the amantadine.”
She noted that the edema can start 1 week after beginning amantadine treatment, sometimes months later and sometimes years later.
“Most of the time when you stop the drug, it goes away quickly – 2 weeks to a month,” Hrubiec added.
“You don’t really think about amantadine causing corneal issues,” she concluded. “Maybe you don’t see many patients who are taking this drug. But it’s nice to have this in the back of your mind that this drug could be the cause of certain ocular effects.” – by Nancy Hemphill, ELS, FAAO
Reference:
Hrubiec K. Corneal edema secondary to amantadine. Presented at: Optometry’s Meeting; Washington; June 21-25, 2017.
Disclosure: Hrubiec reported no relevant financial disclosures.