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P.N. Youssef, E.P. Herlihy, T.T. Shen; Treatment of Calcium Band Keratopathy Using EDTA Chelation With an Epithelial Flap and LASEK Instruments . Invest. Ophthalmol. Vis. Sci. 2005;46(13):2706.
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© ARVO (1962-2015); The Authors (2016-present)
Purpose: To report a new approach in EDTA chelation for calcium band keratopathy with creation of an epithelial flap using standard LASEK instruments. Methods: This is a case report of a monocular diabetic patient who developed activity–limiting vision loss from band keratopathy in his functioning eye. We used a LASEK–like approach for the EDTA chelation for treatment of his band keratopathy. The corneal epithelium was first treated with 20% ETOH using a 9.5 mm LASEK alcohol well. A surgical spear was used to remove the alcohol followed by copious BSS irrigation. The epithelial flap was then peeled back leaving an intact superior hinge. EDTA solution (0.05 M, for 4 minutes) was then applied to the stromal bed using the same LASEK well. The EDTA solution was removed completely from the well with a surgical spear, followed by irrigation with BSS. Upon examination of the cornea it was determined that the stromal calcium deposits were adequately removed. The epithelium was then repositioned back on to the stromal bed and a bandage contact lens was placed over the epithelial flap. The patient was discharged on topical antibiotics and steroids. Results: Our patient experienced minimal pain post–operatively and was able to function with the bandage contact lens in place. Complete re–epithelialization was achieved within one week. At one–month post operatively, the patient's best corrected visual acuity was 20/25, consistent with his retinal potential. Conclusions: Visually significant calcium band keratopathy may be treated with the application of EDTA to the corneal stroma utilizing LASEK technique to create an epithelial flap under topical anesthesia. This approach provides functional vision immediately post operatively with minimum discomfort. Isolating the EDTA solution to the corneal stroma using the LASEK well improves the efficiency of calcium binding and minimizes potential irritation to the ocular surface.
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