title: Corneal perforation: another side effect of nicorandil.
abstract: BACKGROUND
  Nicorandil is an antianginal drug used for 20 years in Japan and introduced in France in 1994. Since 1997, side effects such as mucocutaneous ulcerations have regularly been reported.
  
  
  OBJECTIVE
  To describe the first case of a patient with a spontaneous corneal perforation associated with mucocutaneous ulcerations while taking Nicorandil.
  
  
  METHODS
  A 81-year-old patient, with no past history of ocular disease but a long past history of cardiovascular disease, presented with a spontaneous paracentral corneal perforation. This was consecutive to 5 months of recurrent keratoconjunctivitis and mucocutaneous ulcerations resistant to conventional therapy. (He was taking nicorandil for 5 years.) A penetrating keratoplasty was performed in emergency.
  
  
  RESULTS
  Inflammatory and infectious causes of spontaneous corneal perforation were ruled out. After initial uneventful post-operative wound healing, an epithelial ulcer appeared on the graft. Dermatologists suggested the iatrogenic role of nicorandil and the drug was discontinued. Both mucocutaneous and corneal ulcerations resolved rapidly.
  
  
  CONCLUSIONS
  Although mucocutaneous ulcerations have been attributed several times to nicorandil, this is, to our knowledge, the first major corneal damage due to this antianginal drug. Timing, pattern of illness, absence of other aetiology, recurrence of epithelial ulceration on the corneal graft and its spontaneous healing after nicorandil discontinuation make it highly apparent probable that nicorandil was directly involved in this corneal perforation.
  
  
  CONCLUSIONS
  Ophthalmologists and dermatologists should be aware of the risk of severe but reversible corneal ulcerations in patients treated with nicorandil. A pharmacovigilance warning statement should be compulsory.
authors.affiliation: Department of Ophthalmology .
authors.forename: Nelly
authors.initials: N
authors.lastname: Campolmi
authors.forename: Claire
authors.initials: C
authors.lastname: Guy
authors.forename: Elisa
authors.initials: E
authors.lastname: Cinotti
authors.forename: Fabien
authors.initials: F
authors.lastname: Forest
authors.forename: Philippe
authors.initials: P
authors.lastname: Gain
authors.forename: Camille
authors.initials: C
authors.lastname: Philippe-Zech
authors.forename: Anne Sophie
authors.initials: AS
authors.lastname: Gauthier
authors.forename: Gilles
authors.initials: G
authors.lastname: Thuret
mesh_terms: D000369:Aged, 80 and over; D002317:Cardiovascular Agents / Q000009:adverse effects*; D057112:Corneal Perforation / Q000139:chemically induced*; D003320:Corneal Ulcer / Q000139:chemically induced*; D006801:Humans; D008297:Male; D020108:Nicorandil / Q000009:adverse effects*; D012883:Skin Ulcer / Q000139:chemically induced
chemical_list: D002317:Cardiovascular Agents; D020108:Nicorandil
keywords: Corneal perforation; mucocutaneous lesion; nicorandil