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"Cracked-mud" ciprofloxacin precipitates on a corneal graft
Tasha Y Tanhehco1, Stephen V Chiavetta, Paul P Lee
1Duke University Eye Center, Duke University Medical Center, Durham, North Carolina 27710, USA.
Abstract:
The authors describe an extreme case of ciprofloxacin deposition on the corneal graft of a 67-year-old man with a history of penetrating keratoplasty for corneal ulcer and perforation, who presented with dense, gray deposits on the anterior corneal surface after being treated with ciprofloxacin for an epithelial defect. The deposits resolved after ciprofloxacin was discontinued. The non-physiologic pH of the drug formulation is thought to trigger corneal precipitates, and it remains to be seen whether fourth-generation fluoroquinolones will have a lower incidence of ocular precipitates.
Insights
Ciprofloxacin eye drops can cause corneal deposits in transplant patients. Discontinuing the antibiotic led to deposit resolution, suggesting a link to the drug's formulation.
Area of Science:
- Ophthalmology
- Corneal Medicine
- Pharmacology
Background:
- Penetrating keratoplasty (corneal transplant) is a surgical procedure to restore vision.
- Corneal ulcers and perforations are severe conditions requiring such transplants.
- Post-operative care often involves topical antibiotics to prevent infection.
Observation:
- A 67-year-old male patient developed dense, gray deposits on his corneal graft.
- These deposits appeared after treatment with ciprofloxacin for an epithelial defect.
- The patient had a history of penetrating keratoplasty for a corneal ulcer and perforation.
Findings:
- The corneal deposits were attributed to ciprofloxacin deposition.
- Discontinuation of ciprofloxacin resulted in the complete resolution of the deposits.
- The non-physiologic pH of the ciprofloxacin formulation is hypothesized as the causative factor for precipitates.
Implications:
- This case highlights a potential adverse effect of ciprofloxacin in corneal transplant recipients.
- Further research is needed to determine if newer fluoroquinolones have a reduced incidence of ocular precipitates.
- Clinicians should be aware of this potential complication when prescribing fluoroquinolones to post-keratoplasty patients.
