CASE SUMMARY: AMIODARONE KERATOPATHY WITH IRREGULAR ASTIGMATISM AND CATARACT
A 70-year-old male was referred for cataract evaluation due to decreased best-corrected visual acuity (BCVA), measured at 20/80 in the right eye and 20/60 in the left eye. His manifest refraction was OD -2.75 -1.75 × 60 and OS -3.25 -2.75 × 40.
CLINICAL FINDINGS:
Slit-lamp biomicroscopy revealed bilateral whorl-like corneal epithelial opacities consistent with amiodarone keratopathy (grade 3), most pronounced inferiorly but extending centrally. Both eyes exhibited 2–3+ nuclear sclerosis and 2–3+ cortical changes. Fundus examination and macular OCT were within normal limits. Computerized corneal topography demonstrated mild irregular astigmatism in both eyes. Standard automated perimetry showed no visual field defects.
MANAGEMENT:
The risks and benefits of cataract surgery were reviewed. The patient underwent uneventful cataract extraction with implantation of a toric intraocular lens (IOL) in each eye to address the preexisting regular astigmatism. Postoperatively, uncorrected distance visual acuity improved to 20/30 (OD) and 20/25– (OS), matching or exceeding previous best-corrected levels.
DISCUSSION:
This case illustrates a rare presentation of visually significant amiodarone-induced keratopathy, which contributed to irregular astigmatism and reduced best-corrected acuity. Although epithelial irregularity was evident, epithelial debridement was not indicated due to the high likelihood of recurrence and the need to continue amiodarone, a life-saving antiarrhythmic medication. Cataract surgery with toric IOL implantation provided significant visual rehabilitation.
FINAL THOUGHTS:
This case illustrates the careful decision-making required when managing cataract surgery in the setting of amiodarone keratopathy. Although typically benign, amiodarone-induced epithelial changes can contribute to visual decline when combined with cataract and corneal irregularity. Proceeding with cataract extraction and toric IOL implantation led to meaningful visual improvement, despite the continued need for amiodarone therapy.
Ultimately, the case highlights the importance of individualized surgical planning, particularly when multiple factors affect the ocular surface. With thorough assessment and tailored treatment, patients can achieve excellent visual outcomes while maintaining necessary systemic medications.
