CORNEA EWAP DECEMBER 2023 43 research, as Dr. Wilson noted that patients who have been treated so far only had scarring for no more than a year or two. “The question is if it would still work on someone who had a terrible herpes simplex infection 10 years ago and has a scarred cornea,” he said. Dr. Wilson said the use of losartan could have applications beyond the cornea as well, which makes it an exciting option to keep studying. He noted research being done by Victor Perez, MD, looking at losartan applications on different conjunctival fibrotic diseases, such as Stevens-Johnson syndrome, graft versus host disease, and bullous pemphigoid. None of these have very effective treatment, Dr. Wilson said, and the end pathology is transforming growth factor beta-mediated fibrosis of the conjunctiva. It may also be useful in glaucoma because one of the primary problems glaucoma surgeons face when patients need to have a conjunctival filtering bleb is that those procedures can fail by fibrosis caused by myofibroblasts. When using tubes, those can fail by myofibroblasts causing encapsulation of the tube. Losartan could penetrate the conjunctiva and be effective for those, he said. He noted that it could be worth studying this as an option for proliferative vitreoretinopathy, which can occur in patients who have retinal detachments or diabetes, because that involves myofibroblast - driven fibrosis affecting the retina and vitreous. Extended delivery devices could potentially be studied as an option for giving losartan in these cases. Further research is needed on the applications that Dr. Wilson is studying, as well as applications in other areas of ophthalmology. Instead of focusing on individual groups, Dr. Wilson wanted to encourage trials to ensure there is data to support the use and proper dosage. “We need the trials, but there are patients out there right now who can benefit from this treatment, and there are no reported complications,” he said. When Dr. Wilson ends his lectures nowadays, he likes to reference his quest for the last 30 years to find a “magic bullet” to treat corneal fibrosis. “It was in my medicine cabinet all along,” he said, noting that he’s been on losartan for hypertension for around 20 years. He said it’s interesting that this drug that is so widely used for other things can be repurposed as such an incredible option for the cornea. EWAP References 1. Wilson SE. Topical losartan: practical guidance for clinical trials in the prevention and treatment of corneal scarring fibrosis and other eye diseases and disorders. J Ocul Pharmacol Ther. 2023;39:191– 206. 2. Sampaio LP, et al. Topical losartan inhibits corneal scarring fibrosis and collagen type IV deposition after Descemet’s membrane - endothelial excision in rabbits. Exp Eye Res. 2022;216:108940. 3. Sampaio LP, et al. Topical losartan and corticosteroid additively inhibit corneal stromal myofibroblast generation and scarring fibrosis after alkali burn injury. Transl Vis Sci Technol. 2022;11:9. 4. Pereira-Souza A, et al. Topical losartan for treating corneal fibrosis (haze): first clinical experience. J Refract Surg. 2022;38:741– 746. Editors’ note: Dr. Wilson is Professor of Ophthalmology and Director of Corneal Research, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio. He and the Cleveland Clinic have submitted a patent on the use of topical losartan and other angiotensin II receptor blockers to prevent and treat corneal scarring fibrosis.
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