Corneal lipidosis in patients with the acquired immunodeficiency syndrome.
OBJECTIVE
Certain drugs bind to anionic phospholipids of lysosomal membranes and produce progressive intracellular accumulation of lamellar inclusions. We studied two patients treated for opportunistic infections associated with the acquired immunodeficiency syndrome (AIDS), who developed bilateral ocular surface changes suggestive of drug-induced corneal lipidosis.


METHODS
Two patients with AIDS had translucent vacuoles within the corneal epithelium and mild conjunctival hyperemia. Because the differential diagnosis included microsporidial keratoconjunctivitis, biopsies of the ocular surface were performed for histopathologic analysis.


RESULTS
Transmission electron microscopy of corneal epithelial debridement and conjunctival biopsy specimens showed intracellular, electron-dense lipoidal bodies and multilaminated lysosomal inclusions suggestive of a drug-induced lipidosis. Both patients also had tubuloreticular inclusions in conjunctival capillary endothelial cells. The ocular surface changes resolved within one to three months after dosage reduction or discontinuation of systemic ganciclovir and acyclovir.


CONCLUSIONS
Drug-induced phospholipidosis is a cause of punctate corneal epitheliopathy during AIDS, but the responsible agent remains to be identified.
Wilhelmus
K R
KR
Department of Ophthalmology, Baylor College of Medicine, Houston, TX.
Keener
M J
MJ
Jones
D B
DB
Font
R L
RL
D017088:AIDS-Related Opportunistic Infections / Q000150:complications / Q000188:drug therapy; D000163:Acquired Immunodeficiency Syndrome / Q000150:complications*; D000212:Acyclovir / Q000009:adverse effects* / Q000627:therapeutic use; D000328:Adult; D001706:Biopsy; D003315:Cornea / Q000187:drug effects / Q000648:ultrastructure; D003316:Corneal Diseases / Q000139:chemically induced* / Q000473:pathology; D015774:Ganciclovir / Q000009:adverse effects* / Q000627:therapeutic use; D006801:Humans; D008064:Lipidoses / Q000139:chemically induced* / Q000473:pathology; D008297:Male
D015774:Ganciclovir; D000212:Acyclovir