J Korean Med Sci.  2004 Aug;19(4):611-615. 10.3346/jkms.2004.19.4.611.

New Treatment for Band Keratopathy: Superficial Lamellar Keratectomy, EDTA Chelation and Amniotic Membrane Transplantation

• Kwon YS
• Song YS
• Kim JC

• KMID: 2157696
• DOI: http://doi.org/10.3346/jkms.2004.19.4.611

Abstract

We report two cases of band keratopathy who were treated with thick amniotic membrane that contained a basement membrane structure as a graft, after ethylenediaminetetraacetic acid chelation with trephination and blunt superficial lamellar keratectomy in the anterior stroma. In each case, basement membrane was destroyed and calcium plaque invaded into anterior stroma beneath Bowman's membrane. The calcified lesions were removed surgically, resulting in a smooth ocular surface, and the fine structures of band keratopathy were confirmed by pathologic findings. After that, amniotic membrane transplantation was performed to replace the excised epithelium and stroma. Wound healing was completed within 10 days. Stable ocular surface was restored without pain or inflammation. During the mean follow-up period of 13.5 months, no recurrence of band keratopathy was observed. This combined treatment is a safe and effective method for the removal of deep-situated calcium plaque and allowing the recovery of a stable ocular surface.

Keyword

Amnion; Band Keratopathy; Covneal Diseases; Edetic Acid

MeSH Terms

Amnion/*anatomy & histology/*transplantation
Calcium/metabolism
Chelating Agents/*therapeutic use
Cornea/pathology/surgery
Corneal Diseases/*drug therapy/pathology/*surgery
Edetic Acid/*therapeutic use
Female
Humans
Male
Middle Aged

Figure

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  Fig. 1 (A) Calcium is deposited on the cornea (visual acuity: light perception). (B) Multiple calcium impactions and calcium deposit are observed in the stromal layer (H&E, ×200). (C) Deposited calcium is seen in stromal layer (asterisk). Destroyed basement membrane is observed in the degenerated stromal space (arrow) (×4,100).

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  Fig. 2 (A) Calcified plaque and pseudopterygium is seen (arrow) (visual acuity: perceptive to hand motion). (B) On postoperative 4 months, permanent amniotic membrane graft and clear cornea is seen. (C) Impacted calcium was seen over (arrow) and below (arrow head) the Bowman's membrane. And degenerated and destroyed stroma was observed (asterisk). (H&E, ×200).

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