This video shows an eye with significant cornea band keratopathy, and how it is removed with EDTA chelation.
About this condition
Band Keratopathy, is a precipitation of calcium salts that forms under the epithelium. It occurs in a band pattern across the middle cornea that is most exposed to air. The believe is that evaporation of tears allows calcium and phosphate to increase in concentration and precipitate in this intrapalpebral space.
Now … why doesn’t EVERYONE get band keratopathy? We believe that elevation of the surface pH level, which occurs with conditions such as chronic inflammation, may change the calcium solubility and lead to high rates of precipitation. This theory is supported by the fact that these calcium bands don’t go all the way to the limbus because the limbal blood circulation here has a buffering effect on pH.
On exam, you can see a layer of white material or plaques at the level of bowmans layer and even in the anterior stroma. You can sometimes see small round holes in this plaque which are where corneal nerves break through bowman’s membrane on their way up to the epithelium.
If sparse, band keratopathy may go unnoticed by the patient. However, with extensive deposition in the visual axis, acuity can be affected. Also, epithelial cells don’t stick down well to calcium plaques and these patients can have recurrent corneal erosions and discomfort. Vision and comfort are both reasons to consider a surgery.
Debridement:
Calcium can be removed (like in this video) in a minor procedure room. After anesthetizing the eye, the cornea is bathed with 2% EDTA solution. This solution can be applied using Weck-cel sponges or by using a funnel to bath the cornea. The surface epithelium and underlying calcium is than scraped off using a blunt spatula or careful application of a curved scalpel. Small deposits remove easily, but larger plaques can be tenacious requiring 30 minutes or more of additional chelation/scraping. The goal is to clear the central visual axis.
An excimer laser can be used to polish the underlying cornea if significant irregularities exist. However, you definitely DON’T want to use that laser to remove the calcium … the laser will preferentially remove stroma and you’ll end up with significant irregular astigmatism.
Potential Ocular Associations with Band Keratopathy
Chronic Uveitis
JRA
Phtisis
End stage glaucoma
Topical steroid (with phosphate)
Pilocarpine with mercury based preservatives
Silicone Oil
Intraocular tPA
If a patient presents to you with no signs of ocular cause, consider drawing a serum calcium, phosphate, parathyroid, and sarcoid labs (ACE, lysosyme).
Systemic diseases associated with high calcium
Paget disease
Hyperparathyroidism
Vitamin D excess
Kidney Failure
Sarcoidosis
High Phosphate
Download this video for powerpoint
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bandkeratopathy.wmv (9.0 meg, Windows video file) bandkeratopathy.mov (Quicktime format coming soon)
Dear Mr. Root:
Thanks for your excellent videos.This is the best website for ophthalmologists.
Comment by dr. hamid reza anvari — December 11, 2007 @ 2:32 pm
Wanderful videos !. Congratulations.
Dr JL Sarasa
Comment by Dr Jose L. Sarasa — June 27, 2008 @ 11:49 am
I am an Ophthalmic Tech. and saw a band keratopathy in one of our patients today so I decided to look it up on line and found your website. I love it and have bookmarked it for future reference. Thank you for a most interesting and informative website.
Susan
Comment by Susan Wiik — October 14, 2008 @ 8:21 pm
I’m a pharmacist and I had a couple of questions about the EDTA you are using. Is this a sterile product or are you using a non-sterile research grade EDTA solution? Also, are you purchasing this as a 2% solution or is it being diluted at your facility with something isotonic to the eye (like BSS)?
Comment by Casey Diekmann — January 11, 2009 @ 6:03 pm
Dear sir,
Thank you very much for giving this excellent information.2 years ago I had this EDTA treatment in The netherlans and had a terrible post operative pain for 3 days.My doctor told me there is no way to anestesize the pain.Next week I will have a new treatment.Can you help me ?
sincerely,
Wytse Mellema
Comment by wytse mellemamellema@planet.nl — October 14, 2009 @ 12:04 pm
Hey, Tim! Wow this site is AMAZING! Thanks for helping all the pictures we see in books come to life, its obvious you put a lot of work into this and just want to let you know your efforts are greatly appreciated!
I am an OR nurse and have not seen this procedure. I decided to research it before the start of the case for information and came across your site. It was excellent. Thank you
Comment by Jon Ruderman MD — April 6, 2010 @ 2:01 pm
I like the procedure. Where I can get the 2% EDTA sterile solutions.I have seen doctors are using in Kim’s eye Hospital, Seoul, Korea. We have many patients in Bangladesh. Can you suggest how I can have the EDTA solution?
Dr.Mamun
Comment by Dr.Mamunur Rashid — April 24, 2010 @ 10:36 pm
Interesting blog, not like the others! I really love your blog. I am trying to search more
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