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Vortex keratopathy fabry s related or amiodarone induced hypothyroidism – Amiodarone-induced multiorgan toxicity with ocular findings on confocal microscopy.

Hill, J.

David Stewart
Saturday, October 14, 2017
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  • Zhang F

  • Drug induced maculopathy.

  • Martinez JA

  • Unsteady separation in vortex-induced boundary layers.

  • FDA Food and drug administration, USA has approved cenegermin-bkbj ophthalmic solution 1 drop to be used 6 times a day for 8 weeks for this indication.

Publication types

Galor A. Secondary infection with microbial agents results in the infiltration of inflammatory cells into the cornea. For exposure keratopathy secondary to congenital or acquired lid coloboma, a pedicle graft or flap needs to be done. Long P

Microbicides are products that can be applied to vaginal or rectal mucosal surfaces with the goal of preventing, or at least significantly reducing, the transmission of sexually transmitted infections. Velayati A. Lelli GJ. Shin YJ.

This difference was not significant ; Table 1. Fabry disease is caused by a genetic mutation at q22 of the X chromosome, and it results in a deficiency of the alpha-galactosidase A enzyme. In addition, we attempted to determine the pathogenesis of these two keratopathies, and the clinical course of amiodarone-induced keratopathy was examined regularly by slit-lamp biomicroscopy and IVCM. Figure 2: Another example of similar findings in a patient taking amiodarone.

Journal of Ophthalmology

Cicatricial ectropion, Bell's palsy, and proptosis may be self-evident. The primary step for skin discoloration is cessation of amiodarone. Nuijts RMMA

Was it thickened Dua's layer? Although corneal deposition is not an indication for drug keratopatthy, patients receiving this medication should be monitored for symptoms related to corneal deposition and ocular toxicity. Oray M,Toker E, Tear cytokine levels in vernal keratoconjunctivitis: the effect of topical 0. Partial corneal recovery following selective trabeculoplasty-induced keratopathy: Longitudinal analysis through scheimpflug imaging. Scurrell E Shorter E. Clin Exp Dermatol.

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Suggested citation format : Graff JM. The microdots were detected in the stroma More related articles. Ishida, M. Posterior polymorphous keratopathy.

S68—S73, Bicer, G. Erdurmus, Y. Cotsarelis, S. Miyai, S. Indistinguishable pattern of amiodarone-induced vortex keratopathy from FD related cornea verticillata may confuse the diagnosis if solely considered.

  • Singhal D Alshehri M

  • The amiodarone-induced keratopathy was first detected by IVCM at an average of

  • There are also less common ocular findings in Fabry disease including cataracts and conjunctival and retinal vessel tortuosity [ 367 ]. Campos E

  • Transient Cornea Verticillata of Unknown Etiology.

  • Repetitive magnetic stimulation protects corneal epithelium in a rabbit model of short-term exposure keratopathy. Nakagawa S

Alp and H. Fabry disease: a review. Jump to: navigationsearch. Confocal laser-scanning microscopy allows differentiation between Fabry disease and amiodarone-induced keratopathy. View form.

Rekas M. Baenninger P. Zhang Y Wozniak RAF. Bladen JC Corneas with pre-existing compromised but non-decompensated endothelial pumps are largely at risk of developing striate keratopathy. Culp WTN

References

Neurotrophic Keratopathy in Pediatric Patients. Loyola Arancibia AE Corneal complications following Post Kala-azar Dermal Leishmaniasis treatment.

Toledano H Gaona-Alvarez C The Journal of Cell Biology. The literal meaning of keratopathy is relxted disease of the cornea. Hall MN Introduction A whorl-shaped corneal dystrophy is present in patients with Fabry disease named vortex keratopathy or cornea verticillata because of the whorl-shaped appearance of the cornea [ 1 ]. Borasisi G.

Cosgrave, J. Carpineto, E. An informed consent for the injections, examinations, and measurements was obtained from all the subjects, and the procedures used conformed to the tenets of the Declaration of Helsinki. Amiodarone-induced cornea verticillata.

Ocular Surface Disease: Advances in Diagnostics and Therapeutics

Lim EWL Corneal chrysiasis. In some cases, viral fever can also act as a trigger. Exophiala lecanii-corni keratitis presenting as a serpiginous pigmented superficial lesion: a case report. Savage DE

Fabry nephropathy: indications for screening and guidance for diagnosis and treatment by the European Renal Best Practice. Amiodarone-induced keratopathy has been reported to develop 1 to 3 months after beginning the amiodarone and is progressive. Learn more. Sun, and R. The in vivo confocal microscopical examinations revealed that clusters of cells with a highly reflective cytoplasm were present in the superficial to the basal layers of the corneal epithelium Figure 5. Carpineto, E.

  • Matlock HG

  • The amiodarone-induced keratopathy was first detected by IVCM at an average of

  • Cited by: 1 article PMID:

  • The in vivo confocal microscopy revealed microdots in the stroma in 5 of 8 patients and in the endothelial cells in 2 patients with amiodarone-induced keratopathy.

Regulation of Vocal-Motor Plasticity Dopaminergic projections to the basal ganglia and nucleus accumbens shape the learning and plasticity of motivated behaviors across species including the regulation of vocal-motor plasticity and performance in songbirds. MPS presents with diffuse corneal haze due to the diffuse deposition of mucopolysaccharides in the cornea. Huang Z. Kamonporn N

Bilateral annular lipid keratopathy with ghost vessels. Dermatologic examination revealed bluish discoloration on the nose and cheeks [ Figure 1a ]. Superficial punctate keratopathy and vernal keratoconjunctivitis related keratopathy: On examination, punctate fluorescein stating is noted. Acta ophthalmologica.

1. Introduction

Amiodarone is widely used for treatment of atrial fibrillation. Follow Us. Fukuda, T.

  • Olivieri A. Arriola-Villalobos P

  • In the 3 patients with Fabry disease, slit-lamp biomicroscopy detected white or yellow powdery corneal deposits arranged in a whorl pattern Figure 4.

  • Expression profiles and potential corneal epithelial wound healing regulation targets of high-mobility group box 1 in diabetic mice.

Amiodarone-induced keratopathy has been reported to develop 1 to 3 months after beginning the amiodarone and is progressive. Amiodarone-induced keratopathy developed in 7 of the 8 patients, and it was detected as early as 7 days by IVCM and 14 days by slit-lamp biomicroscopy. Joint Bone Spine. Indistinguishable pattern of amiodarone-induced vortex keratopathy from FD related cornea verticillata may confuse the diagnosis if solely considered.

Band shaped relates Visual impairment and cosmetic blemish are the major concerns. Lipid keratopathy: The patient gives a history of gradual decline in visual acuity. Touzeau O,Bourcier T,Borderie VM,Laroche L, Recurrent infectious crystalline keratopathy caused by different organisms in two successive corneal grafts in the same patient. In Fabry disease, globotriaosylceramide deposits are taken up by the lysosomes of the limbal epithelial stem cells, and they differentiate and migrate to the center of the cornea to form the whorl pattern. Photophobia, colored rings around lights and ocular irritation are the common symptoms of patients with amiodarone-induced keratopathy.

It is also claimed that corneal opacities of FD usually do not affect vision. The pathological findings were detected earlier in 4 of 7 amiodarone vabry by IVCM which may be because IVCM can detect cellular changes which cannot be detected by slit-lamp biomicroscopy, although the difference in the detection time was not statistically significant. Academic Editor: Zisis Gatzioufas. Indistinguishable pattern of amiodarone-induced vortex keratopathy from FD related cornea verticillata may confuse the diagnosis if solely considered. With time, additional arborizing horizontal lines developed and extended to form a whorl pattern Figure 1.

Keratopathy

Kasim B. De La Parra-Colin P Sels L Striate keratopathy: Striate keratopathy is characterized by the presence of corneal edema with Descemet's folds after cataract surgery in an eye with a relatively healthy and clear cornea and in the absence of obvious Descemet's membrane detachment. Siddharthan KS

Highly reflective epithelial cells can be seen in the basal layer to the superficial layers of the corneal epithelial cells. Differential Diagnoses for corneal verticillata: Iron lines ie. The in vivo confocal microscopy revealed microdots in the stroma in 5 of 8 patients and in the endothelial cells in 2 patients with amiodarone-induced keratopathy. It is generally accepted that the corneal epithelial stem cells are in the basal epithelial layer at the limbus, and they differentiate and migrate centripetally across the cornea to the central area [ 23 — 26 ]. Drug-induced lipidoses of the cornea and conjunctiva.

  • Retropupillary iris-claw intraocular lens implantation in aphakic patients.

  • Verticillata almost never cause vision complaints. Ioannidis, A.

  • Koh K A tissue biopsy can yield the causative organism.

  • The Academy uses cookies to analyze performance and provide relevant personalized content to users of our website. Kojima, M.

  • Other drugs, notably antineoplastic agents, produce a fine diffuse corneal haze, sometimes accompanied by decreased vision that can be dose limiting. Miyai T.

First, the limited resolution of the model of IVCM used did not allow us to differentiate the cytoplasmic changes in the inducwd diseases in more detail. Low back pain induced by i. Schermer, S. In addition, we attempted to determine the pathogenesis of these two keratopathies, and the clinical course of amiodarone-induced keratopathy was examined regularly by slit-lamp biomicroscopy and IVCM. Tuppurainen, and K. More Filters.

Allen, E. Yamaguchi, and R. Clusters of epithelial cells with a highly reflective cytoplasm can be seen at the center, paracentral, and limbal regions of the cornea, and the clusters are often seen aligned. The in vivo confocal microscopy revealed microdots in the stroma in 5 of 8 patients and in the endothelial cells in 2 patients with amiodarone-induced keratopathy. Slit-lamp biomicroscopic findings of amiodarone-induced keratopathy of the right eye of case 1.

Vortex Keratopathy: Fabry Related or Amiodarone Induced?

The deposits do not stain and are almost always bilateral. Eight patients who were receiving oral amiodarone therapy and 3 patients with Fabry disease, a mother and her 2 daughters, were examined by slit-lamp biomicroscopy and in vivo confocal microscopy IVCM regularly. Differential Diagnoses for corneal verticillata: Iron lines ie. Recommendations on screening for chloroquine and hydroxychloroquine retinopathy revision.

Francois J. Ruzza A Corresponding author. Infectious crystalline keratopathy: The history of previous penetrating keratoplasty and prolonged use of topical steroids is likely to be present in most of the cases. Espana EM.

PP vortex keratopathy associated with long term use of amiadarone. Results 3. The patient had been on Amiodarone therapy for several years. Amiodarone is a class III antiarrhythmic drug that is effective for the treatment of various types of tachyarrhythmias. Transient Cornea Verticillata of Unknown Etiology. In the amiodarone-induced keratopathy, the highly reflective epithelial cells were first found at the center of the cornea and then spread to the periphery with increasing time on amiodarone.

  • Corneal epithelial defect and underlying stromal edema involving the lower half of the cornea can be noted.

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  • The vortex keratopathy is manifested by opacities that swirl from a point below the center of the cornea and radiate to the peripheral cornea. Fleischer B.

Muir K. In ABK, vitreous is the major insulting agent causing damage to the endothelium due to vitreo-corneal touch. Lohmann T Infectious crystalline keratopathy: In view of resistance to medical management, the definitive management will be re-doing of the penetrating corneal graft. Gao H.

Download other formats More. No visual complaints. PP vortex keratopathy associated with long term use of amiadarone. Corneal verticillata reltaed recognizable as fine golden-brown or gray opacities in the basal epithelium that branch out from a central whorl, usually across the inferior cornea. Patients and methods: Eight patients who were receiving oral amiodarone therapy and 3 patients with Fabry disease, a mother and her 2 daughters, were examined by slit-lamp biomicroscopy and in vivo confocal microscopy IVCM regularly.

54-year-old white male with a known history of atrial fibrillation and hypertension on amiodarone

Vortex keratopathy in a patient with multiple myeloma. However, strong conclusions cannot be made because of the small number of patients, and studies with a larger reated of patients are needed to be able to understand the morphological mechanisms of the two diseases. Read the winning articles. It is generally accepted that the corneal epithelial stem cells are in the basal epithelial layer at the limbus, and they differentiate and migrate centripetally across the cornea to the central area [ 23 — 26 ].

Study on the effectiveness and safety of Foldable Capsular Vitreous Body implantation. Chronic Fatigue Syndrome Chronic fatigue syndrome is a disease characterized by unexplained disabling fatigue; the pathology of which is incompletely understood. The in vivo confocal microscopic examinations also showed microdots in the stroma in 5 and in the endothelium in 2 of the 8 amiodarone patients but in none of the Fabry disease patients. Matsugi T. This case indicates that multiorgan toxicity due to amiodarone may develop even with short-term use and a low maintenance dose. Scurrell E Burnasheva MA.

Download other formats More. Web Privacy Policy Nondiscrimination Statement. This is possible because it has been reported that amiodarone is present in the tear fluids [ 22 ]. No other ocular or health problems. Figure 3.

Kilic SS. Centripetal movement of corneal epithelial cells in the normal adult mouse. Nubile M. Lam TN The literal meaning of keratopathy is a disease of the cornea. Rose-Nussbaumer J.

Vitamin A deficiency and its treatment in captive Sunda pangolins. Toxic keratopathy associated with topical abuse of low-concentration anesthetics: A report of two cases. CLSM revealed hyper-reflective intracellular inclusions in both corneas. Evaluation of emulsified silicone oil with spectral domain-optical coherence tomography and fluorescein angiography.

Abdalla Elsayed M. Journal List J Ophthalmol v. Lueke JN Myocardial stunning is a mechanical dysfunction that persists after reperfusion of previously ischemic tissue in the absence of irreversible damage including myocardial necrosis. Secukinumab-Associated Crystalline Corneal Deposition. Serum ceruloplasmin levels are decreased in the majority of cases of Wilson's disease. Keratopathy related to vernal keratoconjunctivitis VKC : The keratopathy is largely due to the mechanical effect of papillae and also due to the release of various cytokines.

Figure 3. View at: Google Scholar. Drug induced maculopathy. Bicer, G. These medication-lipid complexes are resistant to enzymatic degradation and accumulate as deposits in the cornea. However, the highly reflective epithelial cells were not observed in the peripheral corneal epithelial cells Figure 2.

Kurt RA Maharana PK. Chen X MSCs helped reduce scarring in the cornea after fungal infection when combined with anti-fungal treatment. The Annals of Otology, Rhinology, and Laryngology.

After the discontinuation of amiodarone, the vortex keratopathy fabry s related or amiodarone induced hypothyroidism improves and is resolved in 3 to 20 months [ 111314 ]. History of Present Illness : hypothyroidizm white male with a known history of atrial fibrillation and hypertension. Eight patients who were receiving oral amiodarone therapy and 3 patients with Fabry disease, a mother and her 2 daughters, were examined by slit-lamp biomicroscopy and in vivo confocal microscopy IVCM regularly. These patterns resembled those detected in the amiodarone patients. Unsteady separation in vortex-induced boundary layers. Hanssens, and H. Recent advances in in vivo confocal microscopy IVCM have allowed clinicians to examine the corneal morphology in greater detail.

Int Ophthalmol Clin. Uncertain diagnosis of Fabry disease in patients with neuropathic pain, angiokeratoma or cornea verticillata: consensus on the approach to diagnosis and follow-up. It has varying side effects and vortex keratopathy is 1 of them. Page information. All contributors:. In Fabry disease, globotriaosylceramide deposits are taken up by the lysosomes of the limbal epithelial stem cells, and they differentiate and migrate to the center of the cornea to form the whorl pattern. The duration and dosage of the drugs were recorded until the detection of amiodarone-induced keratopathy, and the final grading score of the keratopathy was done according to that used by Orlando et al.

Gallagher JA. Gold salt deposits in the cornea in a vortexx with rheumatoid arthritis. This feed focuses on the mechanisms that underlie the evolution of pluripotency. Lang SJ. Infectious crystalline keratopathy: Clinical examination along with corroborative history, helps clinicians make a diagnosis of ICK. Keratopathy related to aniridia: The total LSCD results in epithelial changes followed by complete conjunctivalization of the cornea.

Table 1. Ocular features of Fabry disease: diagnosis of a treatable life-threatening disorder. Other agents implicated in cornea verticillata include gentamicin, tamoxifen, meperidine, chlorpromazine, atovaquone, suramin, tilorone, perhexiline maleate, and the tyrosine kinase inhibitors vandetanib and osimertinib.

Mucopolysaccharidoses: Here enzymes necessary to degrade different mucopolysaccharides are deficient resulting in their accumulation. Ocular toxicity of mustard gas: A concise review. Lueke JN Akbas EM. Cited by: 5 articles PMID:

The in vivo confocal microscopic examinations showed highly reflective corneal epithelial cells in 7 of the 8 amiodarone patients and in 2 of fsbry patients with Fabry disease. Tasli NG Spear SA. Menardais B Single-stage endoscopic endonasal approach for the complete removal of trigeminal schwannomas occupying both the middle and posterior fossae. Silverman JIM In vivo confocal microscopic findings of superficial asuprabasal band basal c cell layers of the right eye of case 1.

It has been hypothesized that the amphiphilic drugs that deposit verticillata may form complexes with phospholipids in the cells. Topics from this paper. Article of the Year Award: Outstanding research contributions ofas selected by our Chief Editors.

In Vkrtex disease, deficient activity of the enzyme, alpha-galactosidase A, results in the deposits of sphingolipid degradation Gb3 in lysosomes of various organs including the cornea [ 25 ]. Miyai, S. In the 3 patients with Fabry disease, slit-lamp biomicroscopy detected white or yellow powdery corneal deposits arranged in a whorl pattern Figure 4. Sudduth, and J. Carpineto, E. American Academy of Ophthalmology, EyeWiki.

  • Egrilmez S.

  • Ocular manifestations in Fabry disease: a survey of 32 hemizygous male patients. Abstract Purpose: To compare the morphology of two types of vortex keratopathy: amiodarone-induced keratopathy and the Fabry disease-associated keratopathy.

  • Menassa N

  • Castleberry KM.

  • The morphological changes of vortex keratopathy in Fabry disease and amiodarone-induced keratopathy have been examined by IVCM [ 815 — 19 ].

Kulikov AN Contact Lenses in the Management of Corneal Dystrophies. Filamentary keratopathy: In aqueous deficient dry eyes, lack of tear production results in excessive production of mucus by goblet cells. Yang P.

Tripathi R Amiodarone has high affinity for lipids in the cells especially in the lysosomes, and their interactions result in the accumulation of intracytoplasmic lamellar inclusion bodies. Yuda K. Lipid keratopathy: The patient gives a history of gradual decline in visual acuity. Ginsburg R.

Figure 1. Kook, C. Permanent link. PP vortex keratopathy associated with long term use of amiadarone.

The pathological hypohhyroidism were detected dr bilqees weight loss tip in urdu in 4 of 7 amiodarone patients by IVCM which may be because IVCM can detect cellular changes which cannot be detected by slit-lamp biomicroscopy, although the difference in the detection time was not statistically significant. MPS presents with diffuse corneal haze due to the diffuse deposition of mucopolysaccharides in the cornea. Turk BG 2. Slagsvold JE. Band shaped keratopathy BSK : Chronic ocular inflammation like uveitis, chronic herpetic keratouveitis; phthisis bulbi, keratoconjunctivitis sicca, juvenile idiopathic arthritis, and long-standing silicone oil in the eye may lead to calcific band-shaped keratopathy. Cloudy corneas as an initial presentation of multiple myeloma. Corneal features in trastuzumab emtansine treatment: not a rare occurrence.

The findings of confocal microscopy due to amiodarone-induced keratopathy are described. Sodi A. Alessio G. Joganathan V Kasai K

In Fabry disease, globotriaosylceramide deposits are taken up by the lysosomes of the limbal epithelial stem cells, and they differentiate and migrate to the center of the cornea to form the whorl pattern. Shimazaki J. Drug-induced corneal complications. Outcomes of intravitreal methotrexate to salvage eyes with relapsed primary intraocular lymphoma. A mother and two daughters, ages 32, 8, and 4 years, respectively, who were diagnosed with Fabry disease, were examined by slit-lamp biomicroscopy and IVCM.

INTRODUCTION

Figure 1: Whorled pattern of corneal verticillata on the inferior cornea in patient with chronic amiodarone use. Uncertain diagnosis of fabry disease in patients with neuropathic pain, angiokeratoma or cornea verticillata: consensus on the approach to diagnosis and follow-up. The deposits lead to various side effects, for example, hypohidrosis, cardiomyopathy, renal failure, and vortex keratopathy [ 23 ]. In Fabry disease, globotriaosylceramide deposits are taken up by the lysosomes of the limbal epithelial stem cells, and they differentiate and migrate to the center of the cornea to form the whorl pattern. Suggest Documents.

Usually asymptomatic, it is caused by the deposition of medication, material, and disease byproducts in the basal epithelial layer of the cornea. In Fabry disease, globotriaosylceramide deposits are taken up by the lysosomes of the limbal epithelial stem cells, and they differentiate and migrate to the center of the cornea to form the whorl pattern. Introduction A whorl-shaped corneal dystrophy is present in patients with Fabry disease named vortex keratopathy or cornea verticillata because of the whorl-shaped appearance of the cornea [ 1 ]. Results 3. Mantyjarvi, K. Dora, R. We would like to point out that the differential diagnosis for this clinical entity shouldalso… Expand.

Holmes, and A. Accessed June 19, Oral amiodarone was prescribed to 8 patients, and they were examined by slit-lamp biomicroscopy and IVCM periodically from the beginning of the amiodarone treatment. Fukuda, T.

Mantyjarvi, K. Thus, the slit-lamp biomicroscopic observations in Fabry disease along with the IVCM hyoothyroidism of groups of highly reflective epithelial cells observed to line from the limbus to the central cornea indicate that these cells may be of the same lineage as the limbal epithelial stem cells [ 2730 ]. There are some limitations in our study. This study recognized that repeatable and less invasive observation by IVCM can be a useful method to examine corneal diseases.

Int Ophthalmol, 4 1—2pp. Academic Editor: Zisis Gatzioufas. In Fabry disease, the highly reflective epithelial cells were consistently observed extending from the limbus to the central cornea. According to the different patterns, we hypothesized that the corneal epithelial cells endocytose amiodarone from the tear film during the centripetal migration. Two months prior to this routine follow up, the patient's primary care doctor made a change in the patient's cardiac medications which included the removal of amiodarone from his medication regimen.

  • Metabolic keratopathy: Being bilateral and diffuse in cases of MPS, it may get confused with corneal dystrophies like congenital hereditary endothelial dystrophy or congenital hereditary stromal dystrophy.

  • Ocular manifestations in Fabry disease: a survey of 32 hemizygous male patients.

  • Vasilyeva TA

  • The surrounding endothelial cells slide horizontally to fill in the gaps caused by endothelial cell death. Francois J.

  • Behera G The number of the statements may be higher than the number of citations provided by EuropePMC if one paper cites another multiple times or lower if scite has not yet processed some of the citing articles.

The highly reflective epithelial cells can be seen in the basal layer to the superficial corneal epithelial cell layers. Vortex patterns of the Corneal epithelium. Sodi, A. Section 8, Basic and Clinical Science Course.

A comprehensive Fabry-related pain questionnaire for adult patients. Aimodarone vortex induced by instability. Skip to search form Skip to main content You are currently offline. The procedures used in this study were approved by the Institutional Review Board of Ehime University, number Presentation, treatment, and outcome differences between men and women undergoing revascularization or amputation for lower extremity peripheral arterial disease.

Am Fam Physician. Priyadarsini S Patel V.

Deposits form vodtex faint golden-brown whorl pattern evident in both corneas see Figure 1. Watanabe, and Y. Kaplan and W. Figure 2. Drug-related opacities may appear as horizontal lines with fine branching at the extremities [10]while Fabry disease-related opacities may appear as curving lines that form whorls before becoming almost straight at the periphery. AlpH.

Huang, and T. Zuppardi, M. Drug-related opacities may appear as horizontal lines with fine branching at the extremities [10]while Fabry disease-related opacities may appear as curving lines that form whorls before becoming almost straight at the periphery. This page was last edited on March 29,at

Arriola-Villalobos P Vesce G. Discover the latest research on chronic fatigue syndrome here. Shamov T

Trametinib for orbital plexiform neurofibromas in young children with neurofibromatosis type 1. Kasuya Y Thoene JG In ABK, vitreous is the major insulting agent causing damage to the endothelium due to vitreo-corneal touch.

Amelioration of alloxan-induced diabetic keratopathy by beta-carotene. These findings suggest that the corneal epithelial cells most likely endocytose amiodarone from the tear film in the amiodarone-induced keratopathy. The whorl-like pattern of cornea verticillata results from the centripetal migration of deposit-laden limbal stem cells as the corneal epithelium undergoes natural growth and repair. Hanssens, and H.

Create account Log in. These deposits occur in various levels of the cornea. Fabgy Editor: Zisis Gatzioufas. The microdots were detected in the stroma Two months prior to this routine follow up, the patient's primary care doctor made a change in the patient's cardiac medications which included the removal of amiodarone from his medication regimen. There is no recommended treatment for cornea verticillata.

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