Band Keratopathy Treatment & Management

Medical therapy is ineffective in treating band keratopathy. However, underlying conditions associated with elevated levels of calcium or phosphate should be treated to prevent deposition from recurring (eg, patients on dialysis who subsequently undergo renal transplantation often have a more normal phosphate level).

Surgical debridement of band keratopathy is usually effective in restoring normal vision.

• The procedure can be performed in a minor operating room under topical anesthesia. Proparacaine or tetracaine drops can be used for this purpose. Use of an operating microscope is recommended.

  • Place a lid speculum to hold open the eyelids.
  • Debride the epithelium overlying the calcium with an ophthalmic surgical blade or spatula.
  • Apply 0.05 mol, 1.5% neutral disodium ethylenediaminetetraacetic acid (EDTA), to the corneal surface. Weck-cel sponges soaked in this solution can be used for this purpose. Alternatively, the solution can be placed in a water bath over the cornea to limit ocular exposure.
  • Then, remove calcium deposits with firm scraping of the corneal surface with a blunt spatula. (A Paton spatula works well.) Often, it is necessary to apply solution, followed by scraping several times to remove the plaque. The primary goal is to clear the visual axis. Thin calcium deposits may come off in 5 minutes, while thick plaques may take 30-45 minutes to dissolve.
  • Once this has been accomplished, an assessment of the smoothness of the underlying stroma can be made. If the surface is very irregular, phototherapeutic keratectomy with an excimer laser can be performed to smooth the surface. Ideally, this procedure is performed in the same setting. Note that the excimer laser should not be used to remove calcium. Attempting to remove band keratopathy with the excimer laser alone will result in significant irregular astigmatism since the cornea, not calcium, will be ablated preferentially. The role of the excimer is to polish the surface after the plaque has been removed.^[13]
  • Irrigate the eye thoroughly following the procedure to remove EDTA solution from the conjunctival surface and fornices.
  • Place a bandage contact lens over the cornea. Alternatively, pressure patching or frequent antibiotic ointment can be used.
• Postoperative care includes the insertion of a bandage contact lens that is left in place until the epithelium heals. Topical nonsteroidal agents are useful for pain control immediately following the procedure and for the first few days afterwards. An antibiotic drop should be prescribed with the bandage contact lens in place. Use of a topical steroid drop (eg, prednisolone acetate [not phosphate]) is helpful for comfort and treatment of the inflammation and corneal edema that is often present in the early postprocedure period. These medications can be stopped when the epithelium is healed, and the bandage contact lens is removed (usually within the first 1-2 wk).
• Occasionally, a mild subepithelial haze can be seen weeks after EDTA chelation. This may resolve on its own. A mild topical steroid (eg, fluorometholone 0.1%) may help to resolve this haze. If there is significant damage to the Bowman membrane, the haze may be permanent.

As noted, excessive vitamin D intake has been associated with band keratopathy, as has milk-alkali syndrome. Excessive absorption and serum elevation of calcium is the consequence of these 2 diet-related problems.