Topical losartan and systemic vitamin C to mitigate corneal fibrosis after superficial keratectomy complicated by infection

Introduction: The efficacy of topical losartan in treating corneal fibrosis has been suggested by recent in vivo studies and clinical reports. This is one of the few reported cases of successful treatment of corneal scarring using topical losartan and systemic vitamin C. Patient and Clinical Findings: The case of a 72-year-old woman with presumed epithelial basement membrane dystrophy who developed a corneal opacity after superficial keratectomy of the right eye is presented. Patient presented 2 weeks postoperatively with decreased vision. Anterior segment examination revealed a central corneal opacity on the corneal epithelium with mild infiltrates. Diagnosis, Intervention, and Outcomes: Anterior segment optical coherence tomography confirmed the presence of a superficial anterior stromal central corneal opacity. Patient began treatment of topical losartan 0.8 mg/mL and oral vitamin C 1000 mg that was tapered and monitored throughout 9 months. Significant improvement in corneal opacity was observed at month 2 with almost complete resolution at month 9. Visual acuity had 1-line improvement on the Snellen chart and remained stable. Conclusions: Combined topical losartan and systemic vitamin C demonstrate potential of being adjunct agents to reduce corneal fibrosis secondary to other etiologies. Further clinical studies are needed to optimize dosages, treatment durations, and prevent regression.