Band keratopathy

Acute-onset calcific band keratopathy has been reported in a woman using topical prednisolone (SEDA-20, 372 75). 

Rao GP, O Brien C, Hicky-Dwyer M, Patterson A. Rapid onset bilateral calcific band keratopathy associated with phosphate-containing steroid eye drops. Eur J Implant Refractive Surg 1995 7 251-2. 

Anaphylactoid keratitis Allergic contact keratitis Irritative or toxic keratitis Phototoxic keratitis Toxic calcific band keratopathy Pseudotrachoma Cumulative deposition Microbial imbalance... 

Pupillary block with secondary angle-closure glaucoma Band keratopathy ... 

Steroid-indnced calcinm deposits in the cornea have been reported. Patients with such persistent epithelial defects snch as postoperative inflammation, penetrating keratoplasty, and a history of herpetic keratitis and dry eye have developed a calcific band keratopathy after topical nse of a steroid phosphate formnlation. 

Band keratopathy was first described in 1848 and is a chronic degenerative condition characterized by the deposition of calcium carbonate salts in the superficial corneal layers, most frequently in the interpalpebral area. Although there are many reported cases of idiopathic band keratopathy, some of which seem to have a hereditary component, the most common causes are associated with chronic ocular inflammation and systemic conditions resulting in altered calcium metabolism. Band keratopathy is typically seen in eyes with chronic uveitis, severe superficial keratitis, corneal ulcers, chemical burns, interstitial keratitis (IK), trachoma, phthisis bulbi, and prolonged glaucoma. The chronic anterior uveitis of juvenile idiopathic arthritis is frequently associated with band keratopathy, with one study reporting its development in 66% of patients with juvenile idiopathic arthritis. 

Alterations in systemic calcium-to-phosphorus ratios are another known cause of band keratopathy. This includes hypercalcemia caused by conditions such as hyperparathyroidism, sarcoidosis, and vitamin D intoxication, as well as the elevated serum phosphorus commonly foimd with kidney feilure. Gout can also cause band keratopathy. 

Topical and intraocular medications have also been reported as common causes of band keratopathy. The use... 

In the early stages the patient with band keratopathy remains asymptomatic. However, once the calcification extends into the visual axis, the patient reports decreased visual acuity, visual halos, or a white spot on the eye.The accumulation of calcium can result in disruption of the normal ocular surface, resulting in irritation, photophobia, or RCEs.A patient who develops band keratopathy in a non-seeing eye may be asymptomatic for this condition. 

Reports show some variation in the characteristics of band keratopathy. There may be two morphologic types, with the first type presenting with an intact and smooth epithelium, little discomfort, and deposition of the calcium at the level of Bowman s layer. The second type presents with unstable epithelium in a painful eye. The deposits in the second type tend to extend into the stroma. Band keratopathy occurs much fester in patients... 

Figure 26-13 Band keratopathy arrow) showing the typical Swiss cheese appearance. (Courtesy of Pat Caroline.)...

Treatment of band keratopathy should be directed toward an underlying cause. If the patient s symptoms are mild, artificial tears four to six times a day with lubricating ointment at bedtime may suffice. Patients with mild symptoms may be monitored every 3 to 12 months. 

Kwon,YS, Song YS, Kim JC. New treatment for band keratopathy superficial lamellar keratectomy, EDTA chelation and anmiotic membrane transplantation. J Korean Med Sci 2004 19 611-615. 

Visual acuity is often compromised on presentation in intermediate uveitis. A study in 2001 found a mean entering visual acuity of 6/12 (20/40) in patients with pars planitis on average, children with this disease were foimd to have worse visual acuity than adults at the time of initial presentation. CME is the most common cause of reduced acuity in intermediate uveitis. Other complications, including chronic vitreitis, cataract, and band keratopathy, may ensue in cases of untreated or undertreated intermediate uveitis, resulting in potentially significant visual compromise. 

Biomicroscopy of the anterior segment typically reveals little in cases of intermediate uveitis, although occasionally a few spillover cells may be seen in the aqueous. Hallmark findings of anterior uveitis, such as conjimctival hyperemia, KPs, and iris nodules, are characteristically absent. Late-stage findings may include corneal band keratopathy, anterior and/or posterior synechia, and cataract (most commonly of the posterior subcapsular variety). 

Complications associated with anterior uveitis may include cataracts, glaucoma, band keratopathy, and CME. Posterior subcapsular cataracts are the most commonly encountered lenticular change associated with chronic uveitis. Additionally, it is well known that long-term topical steroid use can induce or accelerate posterior subcapsular cataract development. 

Band keratopathy is a relatively infrequent complication associated with long-standing uveitis. CME may result from the sustained release of prostaglandins however, this complication is fer more likely in cases of intermediate or posterior uveitis. 

In two patients with atypical band keratopathy, the combined use of the preservatives sodium edetate, boric acid, and benzalkonium chloride in eye-drops for glaucoma treatment was identified as the cause (16). 

Kremer I, Fink-Cohen S, Zer I. Atypical band keratopathy associated with antiglaucoma therapy. Ann Ophthalmol Glaucoma 1996 28 164-7. 

Band keratopathy has been reported in patients taking vitamin D (23), as have calcium deposits in the cornea and the conjunctiva (24). 

Gifford ES Jr, Maguire EF. Band keratopathy in vitamin D intoxication report of a case. AMA Arch Ophthalmol 1954 52(l) 106-7. 

Eye drops containing phenylmercuric nitrate as a preservative should not be used continuously for prolonged periods as mercurialentis, a brown pigmentation of the anterior capsule of the lens may occur. Incidence is 6% in patients using eye drops for greater than 6 years however the condition is not associated with visual impairment. Cases of atypical band keratopathy have also been attributed to phenylmercuric nitrate preservative in eye drops. " ... 

Brazier DJ, Hitchings RA. Atypical band keratopathy following long-term pilocarpine treatment. Br J Ophthalmol 1989 73 294-296. 

Other signs Band keratopathy, a reflection of subepithelial calcium phosphate deposits in the cornea, is a very rare finding associated with hypercalcemia. It extends as a horizontal band across the cornea in the area that is exposed between the eyelids. 

The major effects of hyperphosphatemia are related to the development of hypocalcemia (caused by phosphate inhibition of renal la-hydroxylase) and its related consequences, as well as vascular and organ damage resulting from the deposition of calcium-phosphate crystals. Extravascular calcification can result in band keratopathy, red eye, pruritus, and periarticular calcification, especially in renal failure patients (see Chap. 44). In addition, soft-tissue calcifications in the conjunctiva, skin, heart, cornea, lung, gastric mucosa, and kidney have been observed, primarily in chronic renal failure patients." Hyperphosphatemia associated with chronic renal disease may result in renal osteodystrophy because of overproduction of parathyroid hormone. This condition is discussed in detail in Chap. 44. 

Corneal band keratopathy Edetate disodium (disodium EDTA Endrate) is a chelating agent that can be used to remove a band keratopathy (i.e., a calcium deposit at the level of Bowman s membrane on the cornea). After the overlying corneal epithelium is removed, it is applied topically to chelate the calcium deposits from the cornea. 

Silicone oU has had extensive use for long-term tamponade of the retina. Complications from silicone oil use include glaucoma, cataract formation, corneal edema, corneal band keratopathy, and retinal toxicity. 

Nevyas AS, Raber IM, Eagle RC Jr, Wallace IB, Nevyas HJ. Acute band keratopathy following intracame-ral Viscoat. Arch Ophthalmol 1987 105 958-964... 

Spontaneous comeal deposits, characterized by the presence of multiple basophilic granules at the basis of the comeal epithelium, are well described in different rat strains (1, 19) but in the literature a variation in terminology is found i.e. comeal degeneration (1), comeal opacities (12), comeal dystrophy (19) or band keratopathy (33). This pathology is not unique to the rat but has been described in various other laboratory animals such as mouse (34), rabbit (11,13) and dog (associated to hyperadrenocorticism, 31), as well as in man in which comparison is often done with band keratopathy (1). 

Further studies will be useful to elucidate the pathogenesis of these L-680,833-induced comeal opacities and evaluate their potentiality as an animal model of human band keratopathy. However, since no eye abnormalities were observed in dogs and cynomolgus monkeys in studies with comparable dosages of this compound, and since these opacities appeared to be the exaggeration of a spontaneous rat specific ocular changes, they are of no toxicological concern for men. 

P.S. Binder, J.K. Deg, and F.S. Kohl. Calcific band keratopathy after intraocular chondroitin sulfate. Arch. 

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