Eye drops preservative as the cause of corneal band keratopathy in long-term pilocarpine hydrochloride treatment. 2012

Jasna Pavicić-Astalos, and Valentina Lacmanović-Loncar, and Ivanka Petric-Vicković, and Dean Sarić, and Zdravko Mandić, and Tigrena Csik, and Nikola Susić
Department of Ophthalmology, Dr. Tomislav Bardek General Hospital, Koprivnica, Croatia. jpastalos@gmail.com

The aim is to present a patient with severe bilateral corneal complications after long-term antiglaucoma treatment with 1% pilocarpine hydrochloride (Pilokarpin, Pliva, Zagreb, Croatia) and its management. A patient with narrow-angle glaucoma treated with 1% topical pilocarpine hydrochloride eye drops for the last twenty years complained of impaired vision, intermittent visual haloes and eye redness. Ophthalmologic examination showed bilateral band keratopathy, peripheral laser iridotomy, medicamentous myosis, brown nuclear cataract, and synchysis scintillans of his right eye. Band keratopathy was thought to have resulted from the presence of the preservative phenylmercuric nitrate in the pilocarpine hydrochloride eye drops. Treatment of the patient consisted of two separate procedures for both eyes, i.e. phaco trabeculectomy and six months later corneal procedure including abrasion of corneal epithelium followed by removal of the superficial stromal calcium deposits by means of a 3.75% ethylenediaminetetraacetic (EDTA) solution. After phaco trabeculectomy, visual acuity was 0.8 on both eyes. Bilateral visual improvement with visual acuity 1.0 was recorded after corneal treatment with EDTA. In conclusion, one must be aware of preservative complications in long-term topical use, such as band keratopathy that can be visually incapacitating. Surgical treatment using EDTA is safe and effective treatment for band keratopathy.

UI MeSH Term Description Entries
D008297 Male Males
D009883 Ophthalmic Solutions Sterile solutions that are intended for instillation into the eye. It does not include solutions for cleaning eyeglasses or CONTACT LENS SOLUTIONS. Eye Drop,Eyedrop,Eyedrops,Ophthalmic Solution,Eye Drops,Drop, Eye,Drops, Eye,Solution, Ophthalmic,Solutions, Ophthalmic
D010663 Phenylmercury Compounds Organic mercury compounds in which the mercury is attached to a phenyl group. Often used as fungicides and seed treatment agents. Phenyl Mercury Compounds,Phenylmercurials,Compounds, Phenyl Mercury,Compounds, Phenylmercury,Mercury Compounds, Phenyl
D010862 Pilocarpine A slowly hydrolyzed muscarinic agonist with no nicotinic effects. Pilocarpine is used as a miotic and in the treatment of glaucoma. Isopilocarpine,Isoptocarpine,Ocusert,Pilocarpine Hydrochloride,Pilocarpine Mononitrate, (3S-cis)-Isomer,Pilocarpine Nitrate,Pilocarpine, Monohydrochloride, (3S-cis)-Isomer,Salagen,Hydrochloride, Pilocarpine,Nitrate, Pilocarpine
D011310 Preservatives, Pharmaceutical Substances added to pharmaceutical preparations to protect them from chemical change or microbial action. They include ANTI-BACTERIAL AGENTS and antioxidants. Pharmaceutic Aids (Preservatives),Pharmaceutic Preservative,Pharmaceutic Preservatives,Pharmaceutical Preservative,Pharmaceutical Preservatives,Preservative, Pharmaceutic,Preservative, Pharmaceutical,Preservatives, Pharmaceutic
D003316 Corneal Diseases Diseases of the cornea. Corneal Disease,Disease, Corneal,Diseases, Corneal
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000368 Aged A person 65 years of age or older. For a person older than 79 years, AGED, 80 AND OVER is available. Elderly
D015812 Glaucoma, Angle-Closure A form of glaucoma in which the intraocular pressure increases because the angle of the anterior chamber is blocked and the aqueous humor cannot drain from the anterior chamber. Glaucoma, Closed-Angle,Glaucoma, Angle Closure,Glaucoma, Narrow-Angle,Glaucoma, Uncompensated,Glaucoma, Uncompensative,Angle Closure Glaucoma,Angle Closure Glaucomas,Angle-Closure Glaucoma,Angle-Closure Glaucomas,Closed-Angle Glaucoma,Closed-Angle Glaucomas,Glaucoma, Closed Angle,Glaucoma, Narrow Angle,Glaucomas, Angle Closure,Glaucomas, Angle-Closure,Glaucomas, Closed-Angle,Glaucomas, Narrow-Angle,Glaucomas, Uncompensated,Glaucomas, Uncompensative,Narrow-Angle Glaucoma,Narrow-Angle Glaucomas,Uncompensated Glaucoma,Uncompensated Glaucomas,Uncompensative Glaucoma,Uncompensative Glaucomas

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