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P.K. Row, J.C. Affeldt, M.R. Agarwal; Central Isolated Band Keratopathy and Neurotrophic Keratitis . Invest. Ophthalmol. Vis. Sci. 2003;44(13):4751.
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Purpose: Band keratopathy classically develops in the peripheral cornea and progresses centrally. Excluding systemic and toxic etiologies, it has generally been identified with a limited number of ocular conditions including uveitis, longstanding glaucoma, chronic corneal edema, pthisis bulbi, spheroidal degeneration, Norrie's disease, and most recently silicone oil injection. It is not commonly isolated to the central cornea, and has not previously been associated with neurotrophic keratitis (NTK). The purpose of this report is to document for the first time central isolated band keratopathy developing in a group of patients with NTK. Methods: Retrospective chart review Results: Fourteen eyes of thirteen patients presented with apparently long standing central isolated band keratopathy. Five of these eyes (36%) demonstrated a vortex or verticillata calcium deposition pattern. Stages I-III NTK was concurrently diagnosed by clinical appearance (surounding field of punctate keratopathy and/or associated epithelial/stromal defect) in association with profound loss of corneal sensation (Cochet-Bonnet aesthesiometry) as compared to controls. (mean=1.0 mm and 56.3 mm respectively; P=0.0001). Conclusions: Central isolated band keratopathy, particularly with a vortex pattern, appears to represent a previously unrecognized clinical marker for chronic NTK. Such a diagnosis (NTK) carries significant therapeutic and prognostic implications; i.e. need for prophylactic punctal occlusion, and anticipation of complicated wound healing in the event of surgical intervention such as chelation, keratectomy, or corneal transplantation.
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