Tosufloxacin deposits in compromised corneas

To report the adverse effects of topical tosufloxacin in two patients with corneal deposits in compromised cornea.

Tosufloxacin was administered topically to a 13-month-old girl after penetrating keratoplasty in the left eye. Three days posttransplantation, corneal precipitations appeared and thereafter continuously increased. An 80-year-old woman, who maintained postoperative multiple topical medications including tosufloxacin, presented dense white deposits in the left eye a month postoperation. In both cases, the deposits showed a granular pattern and were limited to areas of large epithelial defects. After discontinuation of tosufloxacin, the deposits slowly decreased and completely disappeared in a few weeks. In the former case, corneal re-epithelialization was significantly disturbed and resulted in anterior stromal opacity, whereas visual acuity and visualization of the retina were severely interfered in the latter case.

Tosufloxacin can precipitate especially on compromised corneal surfaces. Therefore, topical tosufloxacin should be avoided in patients who are at risk of losing corneal surface integrity.