Acute calcific band keratopathy: case report and literature review.

UNLABELLED: An 86-year-old patient developed a significant intraocular inflammatory reaction after having phacoemulsification. Topical therapy did not eliminate the inflammation, and tissue plasminogen activator (tPA) was injected into the anterior chamber. A white corneal plaque appeared in the previously clear cornea within days of the injection. The lesion was diagnosed as calcific band keratopathy and successfully treated with ethylenediaminetetraacetic acid chelation. Electron microscopy and elemental analysis of a corneal scraping from the lesion established its composition to be mainly calcium and phosphate, validating the diagnosis. This is the seventh reported case of rapid formation of calcific band keratopathy after tPA injection. The pathogenesis of this rare complication involves multiple factors, including alkalinization of the intraocular pH, increased phosphate concentration, and endothelial dysfunction. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.

[Phototherapeutic keratectomy in recurrences of granular corneal dystrophy after keratoplasty]. / Phototherapeutische Keratektomie bei Rezidiven einer granulären Hornhautdystrophie nach Keratoplastik.

BACKGROUND: Recurrences of granular corneal dystrophy (Groenouw type I dystrophy) after penetrating keratoplasty have been often reported in the literature. Up to now the therapy of these recurrences consists in performing a lamellar or penetrating re-keratoplasty. As those recurrent opacities at first are located in the area of Bowman's membrane and the superficial corneal stroma, a phototherapeutic keratectomy (PTK) with an excimer laser offers a therapeutic alternative to re-keratoplasty. PATIENTS AND METHODS: We describe three eyes of two patients with recurrent opacities on the transplant after successful keratoplasty because of granular corneal dystrophy. In all eyes we performed an excimer-laser PTK (Keratom of Schwind Company, Kleinostheim/Germany, wave length 193 nm) after abrasion of the epithelium with a hockey-knife. The depth of ablation depended on the location of the opacities and was between 7 microns and 35 microns. During the excimer-laser treatment several biomicroscopical slit-lamp controls were performed to make sure whether a sufficient depth of ablation was obtained. RESULTS: The opacities could be totally removed in all eyes by excimer-laser PTK. Postoperatively the visual acuity increased and the patient's photophobia decreased. At the same time a slight progression of hyperopia developed depending on the depth of ablation. During the follow-up period of 5 to 12 months no recurrent opacities could be found until now. CONCLUSIONS: Phototherapeutic keratectomy with the excimer laser seems to be a good alternative to re-keratoplasty in superficially located recurrences of granular corneal dystrophy in a graft after keratoplasty. A slight progression of hyperopia depending on the depth of ablation has to be accepted. The future will show whether there will develops recurrent opacities of the dystrophy after an excimer laser treatment.

[Treatment of band keratopathy (author's transl)]. / Die Behandlung der bandförmigen Keratopathie.

Band keratopathy may be treated either surgically or by using chelating agents. If central corneal scars are present corneal grafting is indicated while in their absence dissolving therapy is preferable. Eight successful corneal grafts and three cases treated medically are reported. Details of treatment with sodium EDTA are described.

Acute corneal calcification.

This case report describes acute unilateral calcium deposition in the central cornea of a uremic patient with corneal exposure. A mechanism of calcium deposition is discussed. It is suggested that a high calcium-phosphorus product, combined with local factors secondary to injury of the exposed corneal epithelial cells, helped to trigger rapid and dense calcification. Details of the removal technique are presented. Constant irrigation of freshly prepared chelating agent combined with vigorous and frequent massage of residual deposits is necessary to completely remove dense concentrations of calcium.

The use of therapeutic soft contact lenses in corneal disease.

Soft contact lenses are being applied as a therapeutic device in various diseases and postoperative conditions of the cornea. Ten cases illustrate several of the clinical conditions in which lenses of approved types may be used, with adjunctive medication in some instances.