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Amiodarone Corneal Topography
Digital Journal of Ophthalmology 1997
Volume 3, Number 3
April 30, 1997
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Steven Patalano, M.D. | Massachusetts Eye and Ear Infirmary, Harvard Medical School
Steven Koenig, M.D. | Medical College of Wisconsin
Robert Hyndiuk, M.D. | Medical College of Wisconsin
Judy Hogatt, M.D. | Medical College of Wisconsin

To study the effects of amiodarone vortex keratopathy on corneal topography.
Amiodarone is commonly used to treat ventricular arrhythmias refractory to other agents. The ophthalmic side effects of amiodarone treatment are well documented and include a keratopathy characterized by subepithelial corneal whorls similar to those noted in Fabry's Disease and asymptomatic anterior subcapsular lens opacities. Most patients develop the characteristic whorl of rust- colored subepithelial deposits within several months of initiating Amiodarone therapy. The deposits are most prominent inferiorly. Previous studies have shown these changes to completely disappear within 7 months of discontinuing treatment. Symptomatic complaints including halos, decreased vision, and photosensitivity are rare and generally have been attributed to the corneal microdeposits. No studies to date, however, have evaluated Amiodarone Keratopathy using the newer computer operated corneal topography units (figure 1).
Figure 1
Eye with Amidodarone vortex kertopathy note the corneal deposits.

Materials and Methods
Four patients with typical Amiodarone Vortex Keratopathy in both eyes underwent EyeSys corneal topography. Each patient had been taking Amiodarone 200 - 400 mg daily for at least 6 months (range 6 to 3 years. Location of corneal deposits FROM amiodarone vortex keratopathy were correlated with findings of corneal topography.
Corneal topography of 7 of 8 eyes revealed an unusual irregular astigmatism with generalized mild inferotemporal steepening consistent with the location of the corneal deposits (figure 2,3 ).One eye of 8 did not demonstrate this pattern of irregular astigmatism.
Figure 2
EyeSys corneal analysis of patient with amiodarone vortex kertopathy OD.

Figure 3
EyeSys corneal analysis of patient with amiodarone vortex kertopathy OS.

This subtle change in corneal topography is probably as important as the subepithelial deposits for the patients' occasional complaints of halos, photophobia and blurry visual acuity. The eye that did not SHOW this astigmatism pattern may represent a slight variation in the typical distribution of subepithelial microdeposits. Further evaluation is necessary to determine if other diseases such as Fabry's which SHOW corneal verticillata will have the same type of corneal topography changes.
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