Abstract
A 73-year-old man presented with bilateral corneal opacities. Slit-lamp biomicroscopy showed vortex and oval-shaped opacities. In vivo confocal microscopy (IVCM) showed findings characteristic of amiodarone-induced keratopathy along with epithelial basement membrane dystrophy (EBMD). The IVCM findings indicated that the oval-shaped opacities can be present with amiodarone-induced keratopathy in patients with EBMD.
A 73-year-old man was referred to the Ehime University Hospital with bilateral corneal opacities. His best-corrected visual acuity was 20/25 OU. The intraocular pressure was 13.0 mmHg and 18.0 mmHg in the right and left eyes. He was diabetic and had a myocardial infarction for which he was taking amiodarone 200 mg/day for 14 years. Slit-lamp biomicroscopy showed vortex-shaped opacities below the center of the cornea in both eyes which is typical of amiodarone-induced keratopathy ( Fig. 1 a and b). He also had oval-shaped opacities in the cornea of both eyes ( Fig. 1 c and d).
In vivo confocal microscopy (IVCM) with HRT-Ⅲ RCM (Heidelberg Engineering, Germany) showed clusters of epithelial cells with reflective cytoplasm at the vortex of the opacities ( Fig. 2 a), and reflective microdots within the stroma. Similar findings have been reported in amiodarone-induced keratopathy. The IVCM also showed an abnormal epithelial basement membrane protruding into the epithelium as seen in patients with epithelial basement membrane dystrophy (EBMD; Fig. 2 b). The IVCM-detected clusters of epithelial cells islands were detected in the ring-shaped structures extending from the basement membrane ( Fig. 2 c). They were co-localized with the oval-shaped opacities detected by slit-lamp biomicroscopy. He had mild cataract and no abnormalities in the posterior segment of the eye. We performed regular medical examination annually, and the opacities were not treated. No significant changes were observed during these examinations.
