title: Amantadine-associated corneal edema potentially irreversible even after cessation of the medication.
abstract: OBJECTIVE
  To describe the clinical features of 3 patients with amantadine-associated corneal edema, including the histopathologic findings from 1 patient who underwent corneal transplantation for irreversible corneal edema.
  
  
  METHODS
  Interventional case series.
  
  
  METHODS
  Three patients who sought treatment at the authors' institution with abrupt-onset, bilateral, diffuse corneal edema associated with systemic amantadine use.
  
  
  METHODS
  Retrospective chart review.
  
  
  METHODS
  Visual acuity, corneal thickness, slit-lamp observations, and histopathologic findings.
  
  
  RESULTS
  The duration of use of amantadine ranged from 2 months to 6 years before onset of corneal edema. Discontinuation of amantadine resulted in resolution of corneal edema in both eyes of 2 patients. A third patient underwent a full-thickness corneal transplantation, and subsequently, edema developed in the grafted cornea. Cessation of amantadine therapy in this patient resulted in resolution of corneal edema in both eyes, but the ungrafted corneal eventually decompensated and became edematous, requiring corneal transplantation. Histopathologic analysis of the cornea buttons showed significant loss of endothelial cells.
  
  
  CONCLUSIONS
  Amantadine can cause corneal edema that begins a few months to several years after institution of therapy, and the edema can occur even in a corneal graft. Prolonged corneal edema in the setting of amantadine use can be irreversible. In cases of corneal edema without an obvious causative disease, the systemic medication list of the patient must be reviewed, and amantadine must be considered as a possible cause.
authors.affiliation: Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio 44195, USA. jengb@ccf.org
authors.forename: Bennie H
authors.initials: BH
authors.lastname: Jeng
authors.forename: Anat
authors.initials: A
authors.lastname: Galor
authors.forename: Michael S
authors.initials: MS
authors.lastname: Lee
authors.forename: David M
authors.initials: DM
authors.lastname: Meisler
authors.forename: Joe G
authors.initials: JG
authors.lastname: Hollyfield
authors.forename: Lynn
authors.initials: L
authors.lastname: Schoenfield
authors.forename: James T
authors.initials: JT
authors.lastname: McMahon
authors.forename: Roger H S
authors.initials: RH
authors.lastname: Langston
mesh_terms: D000328:Adult; D000547:Amantadine / Q000009:adverse effects*; D018712:Analgesics, Non-Narcotic / Q000009:adverse effects*; D001714:Bipolar Disorder / Q000188:drug therapy; D015715:Corneal Edema / Q000139:chemically induced* / Q000503:physiopathology / Q000601:surgery; D015259:Dopamine Agents / Q000009:adverse effects*; D005260:Female; D006801:Humans; D015948:Keratoplasty, Penetrating; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000188:drug therapy; D012189:Retrospective Studies; D014792:Visual Acuity
chemical_list: D018712:Analgesics, Non-Narcotic; D015259:Dopamine Agents; D000547:Amantadine