Eyeworld

50 | EYEWORLD | SEPTEMBER 2023 C ORNEA by Ellen Stodola Editorial Co-Director About the physician Steven E. Wilson, MD Professor of Ophthalmology Director of Corneal Research Cole Eye Institute Cleveland Clinic Cleveland, Ohio L osartan is being studied as a potential treatment for corneal fibrosis and scar- ring. 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 ap- plications 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 pharma- cies in April of this year. Dr. Wilson became interested in research- ing 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 ar- ticle published that showed that losartan inhib- ited fibrosis in the aorta in animal models when given orally." Years later, Dr. Wilson remem- bered 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 be- cause 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 base- ment membrane and still impact the posterior fibrosis, that means it could treat anything in the cornea." Most drugs can't penetrate the intact ep- ithelium 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 devel- op severe scarring fibrosis of the cornea. Any Losartan for the cornea, conjunctiva, glaucoma, and beyond A young contact lens wearer contracted Acanthamoeba keratitis, and topical losartan treatment was used for corneal scarring fibrosis. A. After many months of anti-Acanthamoeba treatment, the infection was cured but the cornea continued to have severe scarring fibrosis. The patient started 0.8 mg/mL losartan in balanced salt solution six times a day. B. After 4 months of treatment with topical losartan, there was a marked decrease in scarring fibrosis. The patient is continuing topical losartan treatment and has experienced no side effects from the treatment. Source: Danyelle Medeiros, MD

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