Clinical Courses Of Corneal Endothelial Dysfunction Due To Gomphocarpus physocarpus Milky Latex-Induced Injury: A Case Series

Abstract

Purpose

To investigate the clinical courses of patients with corneal endothelial dysfunction due to Gomphocarpus physocarpus milky latex-induced injury.

Patients and methods

In this retrospective case series, we included consecutive patients who visited Miyata Eye Hospital or Kagoshima Miyata Eye Clinic between October 2010 and August 2017 and had corneal edema caused by G. physocarpus milky latex-induced injury. Patient information and data on central corneal thickness (CCT), corneal endothelial cell density (ECD), best-corrected visual acuity (BCVA), and treatment were retrospectively reviewed.

Results

Five eyes of four patients were included. The mean age was 79.0 ± 7.1 years. All patients complaining of symptoms visited the hospital 1 or 2 days after the injury. All patients had corneal edema; two of the five eyes showed hyperemia, whereas none showed corneal epithelial defect or blepharitis. The mean CCT was 699.8 ± 95.9 μm at the first visit and decreased to 563.2 ± 74.0 μm 1 week after the injury with treatment with topical steroids and antibiotics. The mean ECD and BCVA were 2695.8 ± 191.3 cells/mm² and 0.22 ± 0.19 at the first visit and 2826.0 ± 132.9 cells/mm² and 0.10 ± 0.09 one week after the injury, respectively.

Conclusion

G. physocarpus caused transient dysfunction of the corneal endothelium and thereby, corneal edema. Accurate diagnosis with history taking is important to ascertain the types of plants the patient has touched and to exclude other possible diagnoses.

Keywords:

• Asclepias physocarpus
• corneal endothelial dysfunction
• corneal edema
• plant toxin

Abbreviations

BCVA, best-corrected visual acuity; CCT, central corneal thickness; ECD, endothelial cell density; IOP, intraocular pressure; logMAR, logarithm of the minimum angle of resolution; SPK, superficial punctate keratitis.

Disclosure

Dr Takashi Ono reports personal fees from Senju Pharmaceutical, Bayer, Kowa Pharmaceutical, and AbbVie GK, outside the submitted work. Dr Yosai Mori reports grants, personal fees from Alcon, J&J, HOYA, Senju Pharmaceutical, Santen pharmaceutical, and Novartis Pharma, personal fees from Kowa Pharmaceutical, grants from Kissei pharmaceutical, Wakamoto, and Shionogi, outside the submitted work. Dr Shiro Amano reports grants, personal fees from Santen Pharmaceutical, personal fees from Senju Pharmaceutical, Otsuka Pharmaceutical, Alcon, AMO, and HOYA, outside the submitted work. The authors report no other conflicts of interest in this work.