Abstract
Purpose :
To describe the risk factors, clinical course, and characteristics of 5 cases of acute calcific band keratopathy presenting at the same institution within 1 month of therapeutic use of topical cenegermin for neurotrophic keratitis.
Methods :
A retrospective chart review of 46 eyes of 46 patients from 2021 to 2023 was conducted. A diagnosis of neurotrophic keratitis, along with treatment using topical cenegermin, was used as inclusion criteria. Of the 46 eyes identified, acute calcific band keratopathy was observed in 5 eyes, all of which completed at least one 8-week course of cenegermin within 1 month of presentation. The 5 eyes of these 5 patients are included in this series along with relevant history, medications, pathology, imaging, and lab findings.
Results :
Of the 46 eyes treated with cenegermin, 5 eyes (10.9%) showed evidence of acute calcific band keratopathy. These patients had a prolonged epithelial defect ranging from 2 to 8 months. Biopsy of the corneal deposits in 1 case confirmed calcification in Bowman’s layer and superficial stroma. All 5 cases showed persistence of calcium deposits after discontinuing cenegermin, prompting superficial keratectomy with EDTA chelation and amniotic membrane ring placement. One patient experienced recurrence despite successful EDTA chelation and required additional treatment. With surgical intervention, 2 cases showed resolution without recurrence to date.
Conclusions :
Topical cenegermin for the treatment of neurotrophic keratitis has been shown to precipitate acute calcific band keratopathy. Herein, we report 5 similar cases which occurred at the same institution within 2 calendar years. All cases showed persistent calcification during use or within 1 month of discontinuation and required multiple treatment modalities. Two patients in this series underwent multiple treatment courses of cenegermin with an interim period of at least four months between treatments. These patients did not demonstrate calcification during their first round of treatment but developed calcification after subsequent use, a finding that has yet to be reported. Ultimately, resolution was achieved in 2 cases after EDTA chelation, with 1 case having recalcitrant calcification despite medical and surgical intervention. Our case series highlights the risk factors, clinical appearance and treatment modalities of acute calcific band keratopathy following cenegermin use.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.