ABSTRACT
In this paper, we report two cases of a 62‑year‑old patient presented with blurred vision and a 45‑year‑old male diagnosed with multiple myeloma who was referred from the Department of Oncology. Slit‑lamp examination, in vivo confocal microscopy (IVCM), systemic work‑up and serum protein electrophoresis were obtained. In both patients, slit‑lamp findings revealed bilateral diffuse subepithelial and anterior stromal crystals and IVCM showed highly reflective deposits in the corneal epithelium and stroma. The first patient was eventually diagnosed with monoclonal gammopathy of undetermined significance following bone marrow biopsy and systemic evaluation. Unusual corneal deposits may constitute the first sign of monoclonal gammopathies. IVCM may be helpful in showing the crystalline nature of the corneal deposits and guiding the clinician to the diagnosis of gammopathies. Both ophthalmologists and oncologists should be aware that corneal deposits may herald a life‑threatening hematologic disease.
ABSTRACT
Las fluoroquinolonas son ampliamente utilizadas para el tratamiento de infecciones oculares bacterianas, ya que tienen actividad tanto para grampositivos, como para gramnegativos. Son fármacos seguros, pero se han descrito depósitos blancos cristalinianos en pacientes con administración frecuente y prolongada;en la mayoría de los casos, ellos resuelven de forma lenta al interrumpir el tratamiento. Si esto no ocurre, los depósitos se deben desbridar. Se ilustran 3 casos operados de catarata que llevaron tratamiento con ciprofloxacino en el posoperatorio, en los cuales se presentaron depósitos corneales y aunque disminuyó la agudeza visual, esta se recuperó después de la queratectomía
Fluoroquinolones are broadly used for the treatment of bacterial ocular infections, since they can act upon both grampositive and gramnegative bacteria. They are safe drugs, but white corneal deposits have been described in patients who frequently take this drug for a long period of time. In most of the cases, the deposits disappear slowly after the treatment is interrupted. If this does not happen, the deposits should be eliminated. Three cases operated on from cataract were presented, who had been taken ciprofloxacin in the postoperative stage and had corneal deposits. Although their visual acuity decreased, it recovered after keratectomy
Subject(s)
Humans , Male , Female , Middle Aged , Ciprofloxacin/adverse effects , Cataract Extraction/adverse effects , Fluoroquinolones/therapeutic use , Case ReportsABSTRACT
En poblaciones tratadas con dosis superiores de amiodarona a las usadas en nuestro medio y sin períodos de suspensión, la literatura correlaciona la frecuencia y la magnitud de los depósitos corneales con la dosis total y la duración del tratamiento. Nos propusimos conocer la frecuencia y la magnitud de los depósitos corneales inducidos por la amiodarona y evaluar su relación con la dosis, los días de suspensión semanal y la duración del tratamiento. Fueron incluidos todos los pacientes de la institución tratados crónicamente con amiodarona por la autora (IV), entre setiembre de 1999 y setiembre de 2000, que consintieron en ser estudiados con lámpara de hendidura. Los depósitos corneales se clasificaron en ausentes, muy leves, leves, moderados y severos. En el análisis estadístico, las proporciones fueron comparadas a través del test exacto de Fisher, las medias entre dos o más grupos a través del test de Kruskal-Wallis y para correlacionar las dosis con el grado de depósitos se utilizó el coeficiente de correlación de Spearman. Se incluyó un total de 21 pacientes (90% hombres), con una edad media de 71,3 años (DS=9,4). El 76% presentó depósitos corneales. Se observó una correlación positiva entre el grado de depósitos y la dosis total de amiodarona (r=0,630; p=0,020), la dosis diaria (r=0,706; p< 0,001) y sobre todo la dosis media semanal (r=0,731; p<0,001). La ausencia de días de suspensión se asoció con depósitos severos (p=0,001). La duración del tratamiento, en cambio, no mostró correlación con los depósitos. Estos resultados pondrían en evidencia la importante influencia que posee el descanso del fármaco sobre este efecto colateral.
SUMMARY Current literature states that in populations receiving uninterrupted, higher than usual –in our daily practice– doses of amiodarone, a correlation between frequency and quantity of corneal deposits against total dosage and length of treatment can be established. We therefore decided to determine frequency and quantity of amiodarone-induced corneal deposits and study their relation to dose, weekly interruptions and length of treatment. Those patients of the institution that were chronically treated by the author (IV) with amiodarone between september 1999 and september 2000, who consented to be studied with a splitlamp were included. Corneal deposits were classified as absent, very light, light, moderate or severe. The statistical analysis was conducted by using the precise Fisher test when comparing proportions, the Kruskal-Wallis test for averages between 2 or more groups and the Spearman coefficient to correlate doses with amount of deposits. A total of 21 patients (90% male) with an average of 71.3 years of age (SD=9.4) were included. In 76% of the patients corneal deposits were found. A direct correlation was found between the amount of corneal deposits and total dose of amiodarone (r=0.630; p=0.020), daily dose (r=0.706; p<0.001) and particularly the average weekly dose (r=0.731; p<0.001). Severe deposits were associated to lack of interruptions (p=0.001). However, no relation was found between deposits and length of treatment. These results would put in evidence the important influence that the periodic interruption of the drug has on this particular side effect.