Southwest, FL | Case of the Day- Band Keratopathy | Cataract & Refractive Institute of Florida

Dr. Croley discusses a case of band keratopathy. The most common treatment for band keratopathy that is visually significant is chelation with EDTA.


Dr. Croley: Hello, and welcome to Case of the Day. I'm Dr. Croley, and today we're going to discuss an interesting patient who came in with a complaint that their vision was blurred, and I wasn't really sure. They weren't really sure how long had been going on for, but slowly over the last year or so their vision had gradually decreased. A lot of times when you see someone come into the office that way, the first thing you think is, "Maybe they have cataracts." In this particular case, this lady did not have cataracts. She had what's called band keratopathy.

Dr. Croley: What she had, actually, is a deposition of calcium and/or phosphorus deposits on the surface of her cornea, the clear part of the eye. This deposits happen usually on the anterior layers of the eye down to a layer called Bowman's membrane. Sometimes it penetrates below Bowman's membrane depending on how long it's been present for, and it actually is a band. It looks like a band across the cornea that is whitish in appearance. If it's dense enough and located in the pupil area, then it can obstruct the vision. In her case, that's what was happening.

Dr. Croley: What causes band keratopathy? It can be from several different causes. If you were a young person and had this develop, then you'd have to worry about is your blood levels of your calcium very highly elevated, such diseases as hyperparathyroidism? It happens in certain multiple myeloma malignancies. It happens in certain people in renal failure. It happens with certain eye diseases such as someone has a very sick eye, they've had a lot of trouble with their eye, and they have what's called phthisis bulbi, which the pressure in the eye is very low or zero and it is a sick eye. People develop calcium deposits in those situations.

Dr. Croley: Chronic trauma to the eye. A drug called Pilocarpine that was used many years ago for glaucoma, the mercury in there could cause that to develop band keratopathy, and so there are several things that can cause it, but there is treatment for it. This lady, we're going to be scheduling her to go in and remove this calcium deposit. The most common treatment is as we go to the operating room and then we place on the eye either a alcohol solution that loosens the epithelium off, or you can actually scrape the epithelium off the cornea, and then you apply EDTA, which is a calcium chelating agent. It binds to the calcium and draws it out of the cornea and sometimes we have to scrape or rub along as it comes loose, and that works pretty well in most cases.

Dr. Croley: After that case is over, we typically apply a self-contact lens to cover over the epithelium has been removed, so the eye is not that painful afterwards. If it doesn't respond well to that, then also laser correction that we use to correct, actually, someone's vision because they're nearsighted or farsighted with a laser, that laser cuts or removes corneal tissue, so you can have a therapeutic PRK or laser treatment in severe cases that don't respond to EDTA.

Dr. Croley: This doesn't happen very often, but when you do see it, then the good thing is is that it is treatable. If you have any questions about this type of thing with the band kerotopahy or any other eye question, you'd be happy to contact us through the website, and we'll try to answer those questions for you. If not, may God grant you with healthy eyes and great vision. You have a great day.