CORNEA 40 EWAP DECEMBER 2023 A young contact lens wearer contracted Acanthamoeba keratitis. Topical losartan treatment was used for corneal scarring fibrosis. After many months of anti-Acanthamoeba treatment, the infection was cured but the cornea continued to have severe scarring fibrosis (A). The patient started 0.8 mg/mL losartan in balanced salt solution six times a day. After 4 months of treatment with topical losartan, there was a marked decrease in fibrosis (B). The patient is continuing topical losartan treatment and has experienced no side effects from the treatment. Source: Danyelle Medeiros, MD by Ellen Stodola Editorial Co - Director Losartan for the cornea, conjunctiva, glaucoma, and beyond Contact information Wilson: wilsons4@ccf.org L osartan is being studied as a potential treatment for corneal fibrosis and scarring. Steven E. Wilson, MD, has been conducting studies on the use of topical losartan in this area. 1 He spoke to EyeWorld about the status of those (mostly animal) studies, experience with off-label applications in human patients, and his thoughts about this option becoming more available. Many compounding pharmacies are now preparing this for use around the U.S., he said, noting that topical losartan was the number one trending medication at compounding pharmacies in April of this year. Dr. Wilson became interested in researching this and has been funded for more than 30 years by NIH and DOD. “Earlier in my career, every week I read the full issue of Science when it came out,” he said. “In 2011, there was an article published that showed that losartan inhibited fibrosis in the aorta in animal models when given orally.” Years later, Dr. Wilson remembered the article and decided to pursue this area of research with a DOD grant, which looked at whether topical losartan would impact topical scarring fibrosis in the cornea. He used several models to research this. The first he chose was descemetorhexis 2 because it had been recently demonstrated that when you remove Descemet’s membrane and endothelium (about an 8-mm patch) in rabbits, they get severe posterior corneal fibrosis. “The reason that appealed to me as the first place to test it is because the epithelium and basement membrane in those corneas is normal,” he said. “If the losartan could penetrate the intact normal epithelium and intact epithelial basement membrane and still impact the posterior fibrosis, that means it could treat anything in the cornea.” Most drugs can’t penetrate the intact epithelium and epithelial basement membrane, Dr. Wilson said. For example, in a patient who has fibrosis after PRK, their epithelium heals normally, but a few months later, they develop severe scarring fibrosis of the cornea. Any drug that doesn’t penetrate the epithelium and epithelial basement membrane is not going to be effective. “The study not only showed that losartan was effective against This article originally appeared in the September 2023 issue of EyeWorld. It has been slightly modified and appears here with permission from the ASCRS Ophthalmic Services Corp.
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