The aim is to present a patient with severe bilateral corneal complications after long-term antiglaucoma treatment with 1%
pilocarpine hydrochloride (Pilokarpin, Pliva, Zagreb, Croatia) and its management. A patient with
narrow-angle glaucoma treated with 1% topical
pilocarpine hydrochloride eye drops for the last twenty years complained of impaired vision, intermittent visual haloes and eye redness. Ophthalmologic examination showed bilateral
band keratopathy, peripheral
laser iridotomy, medicamentous myosis, brown nuclear
cataract, and synchysis scintillans of his right eye.
Band keratopathy was thought to have resulted from the presence of the preservative phenylmercuric
nitrate in the
pilocarpine hydrochloride eye drops. Treatment of the patient consisted of two separate procedures for both eyes, i.e. phaco
trabeculectomy and six months later corneal procedure including abrasion of corneal epithelium followed by removal of the superficial stromal
calcium deposits by means of a 3.75% ethylenediaminetetraacetic (
EDTA)
solution. After phaco
trabeculectomy, visual acuity was 0.8 on both eyes. Bilateral visual improvement with visual acuity 1.0 was recorded after corneal treatment with
EDTA. In conclusion, one must be aware of preservative complications in long-term topical use, such as
band keratopathy that can be visually incapacitating. Surgical treatment using
EDTA is safe and effective treatment for
band keratopathy.