Recognizing Amiodarone-lnduced Cornea Verticillata: A Case Report of Bilateral Cataract and Ocular Drug Deposition

Abstract

Amiodarone is a widely prescribed class III antiarrhythmic agent known for its efficacy in managing refractory arrhythmias. However, it is also associated with several ocular adverse effects, the most characteristic being cornea verticillata. This benign, whorl-like epithelial deposition typically spares visual acuity but warrants clinical awareness.We report the case of a 73-year-old female with rheumatic heart disease and atrial fibrillation on chronic amiodarone therapy (200 mg daily for nine months), who presented with progressive bilateral diminution of vision over five months. Ophthalmic evaluation revealed bilateral cornea verticillata along with grade 3 nuclear sclerosis and posterior subcapsular cataract. Anterior segment optical coherence tomography (AS-OCT) demonstrated hyperreflective deposits localized to the corneal epithelium, confirming the diagnosis of amiodarone-induced keratopathy. The patient underwent uneventful right eye cataract surgery with posterior chamber intraocular lens implantation in the right eye, resulting in satisfactory postoperative visual recovery.This case underscores the need for ophthalmologists to recognize amiodarone-induced corneal changes and differentiate them from other causes of visual decline. While cornea verticillata itself is typically asymptomatic and reversible, coexisting lenticular opacities may substantially impair vision. Close interdisciplinary collaboration between ophthalmologists and cardiologists is crucial for optimal patient management.