Corneal endothelial dysfunction in digoxin toxicity

Corneal endothelial wound healing: understanding the regenerative capacity of the innermost layer of the cornea

Currently, there are very few well-established treatments to stimulate corneal endothelial cell regeneration in vivo as a cure for corneal endothelial dysfunctions. The most frequently performed intervention for a damaged or dysfunctional corneal endothelium nowadays is corneal endothelial keratoplasty, also known as lamellar corneal transplantation surgery. Newer medical therapies are emerging and are targeting the regeneration of the corneal endothelium, helping the patients regain their vision without the need for donor tissue. Alternatives to donor tissues are needed as the aging population requiring transplants, has further exacerbated the pressure on the corneal eye banking system. Significant ongoing research efforts in the field of corneal regenerative medicine have been made to elucidate the underlying pathways and effector proteins involved in corneal endothelial regeneration. However, the literature offers little guidance and selective attention to the question of how to fully exploit these pathways. The purpose of this paper is to provide an overview of wound healing characteristics from a biochemical level in the lab to the regenerative features seen in the clinic. Studying the pathways involved in corneal wound healing together with their key effector proteins, can help explain the effect on the proliferation and migration capacity of the corneal endothelial cells.

Corneal Endothelial Dysfunction as a Manifestation of Digoxin Toxicity

PURPOSE

The purpose of this study was to report a case of corneal endothelial dysfunction and subsequent corneal edema in a patient with digoxin toxicity.

METHOD

This was a case report.

RESULTS

A 77-year-old woman diagnosed with open-angle glaucoma and treated with a topical prostaglandin analog for 5 years developed blurred vision and photopsia in both eyes. Systemic medications included digoxin, furosemide, apixaban, amlodipine, enalapril, and simvastatin. Ocular examination revealed folds in Descemet membrane and corneal stromal edema in both eyes, with normal fundoscopy. Ancillary tests revealed elevated serum digoxin levels. No intervention other than discontinuation of digoxin was initiated. The corneal edema improved after that and resolved in the next 2 weeks.

CONCLUSIONS

We encountered 1 case of corneal edema secondary to corneal endothelial dysfunction in a patient with digoxin toxicity. Special care should be taken to elicit a complete history because ocular signs can be manifestations of systemic alterations with vital importance for patients.

The corneal endothelium: clinical review of endothelial cell health and function

The endothelial cell is a critical structure within the cornea and is responsible for maintaining corneal clarity through its pump function. Endothelial cells are lost over time naturally but can be injured medically, surgically, or as a part of various dystrophies. Monitoring of endothelial cells can be performed clinically or more formally with specular microscopy. In cases of significant compromise, endothelial cells can be transplanted by various endothelial keratoplasty techniques. The future pipeline is bright for possible endothelial cell regeneration and rehabilitation. This article reviews these topics in depth to provide a comprehensive look at the structure and function of the endothelial cell, etiologies of endothelial cell damage, detailed review of iatrogenic causes of endothelial cell loss, and management strategies.

Corneal endothelial dysfunction caused by Asclepias curassavica in a young farmer

Purpose

To introduce a case of corneal endothelial toxicity caused by Asclepias curassavica (Milkweed) in Korea.

Observations

A 37-year-old Asian man presented with decreased vision and redness in the right eye, which developed after contact with Asclepias curassavica. At presentation, best-corrected visual acuity (BCVA) was 20/60 in the right eye. Slit lamp examination demonstrated severe corneal stromal edema with Descemet's folds and conjunctival hyperemia. We prescribed topical prednisolone acetate 1% eye drops (8 times a day), cyclosporine 0.1% (once a day) and oral prednisolone (30 mg a day for 3 days). One day later, the BCVA improved to20/40 and marked improvement in corneal edema was observed. At 5 days, BCVA was 20/22 and anterior segment examination showed minimal corneal edema with resolution of Descemet's folds. At 2 weeks, BCVA was 20/20 in the right eye and corneal edema completely resolved.

Conlcusions and importance

This case suggests that high index of suspicion for toxicity from Asclepias species is necessary when encountered with patients who present with corneal edema after exposure to these plants. Aggressive anti-inflammatory treatment might be helpful for early recovery, at least for young patients.

A Review of Corneal Endotheliitis and Endotheliopathy: Differential Diagnosis, Evaluation, and Treatment

The corneal endothelium plays an integral role in regulating corneal hydration and clarity. Endotheliitis, defined as inflammation of the corneal endothelium, may disrupt endothelial function and cause subsequent visual changes. Corneal endotheliitis is characterized by corneal edema, the presence of keratic precipitates, anterior chamber inflammation, and occasionally limbal injection, neovascularization, and co-existing or superimposed uveitis. The disorder is classified into four subgroups: linear, sectoral, disciform, and diffuse. Its etiology is extensive and, although commonly viral, may be medication-related, procedural, fungal, zoological, environmental, or systemic. Not all cases of endothelial dysfunction leading to corneal edema are inflammatory in nature. Therefore, it is imperative that practitioners consider a broad differential for patients presenting with possible endotheliitis, as well as familiarize themselves with appropriate diagnostic and therapeutic modalities.