Korean J Ophthalmol.  2010 Apr;24(2):73-77. 10.3341/kjo.2010.24.2.73.

Combined Ethylenediaminetetraacetic Acid Chelation, Phototherapeutic Keratectomy and Amniotic Membrane Transplantation for Treatment of Band Keratopathy

• Im SK
• Lee KH
• Yoon KC

• KMID: 945997
• DOI: http://doi.org/10.3341/kjo.2010.24.2.73

Abstract

PURPOSE
The objective of this study is to evaluate the therapeutic efficacy of ethylenediaminetetraacetic acid (EDTA) chelation and excimer laser phototherapeutic keratectomy (PTK) combined with amniotic membrane transplantation (AMT) for the treatment of band keratopathy (BK). METHODS: Eleven eyes in ten patients with BK received combined PTK (ablation zone of central 7.0-7.5 mm, depth of 50 microm), EDTA chelation (0.05 M, 3 minutes), and amniotic membrane transplantation using fibrin glue. Preand postoperative best corrected visual acuities, symptom changes, reepithelialization time, cosmesis, recurrence, and complications were analyzed. RESULTS: Visual acuity improved in three eyes (27.3%) and did not change in eight eyes (72.7%). Symptoms improved in all patients, and the mean reepithelialization time was 10.6+/-5.3 days. The cosmetic results were good in eight eyes (72.7%) and were fair in three eyes (27.3%). During the mean follow-up period of 11.4+/-6.1 months (range, 6 to 23 months), no postoperative complications or recurrences were observed. CONCLUSIONS: The combination of EDTA chelation, PTK, and AMT is safe and effective for the treatment of band keratopathy.

Keyword

Amion; Chelating agents; Excimer lasers

MeSH Terms

Adolescent
Adult
Aged
Aged, 80 and over
Amnion/*transplantation
Chelating Agents/*therapeutic use
Combined Modality Therapy
Corneal Diseases/*therapy
Edetic Acid/*therapeutic use
Female
Humans
Male
Middle Aged
Photorefractive Keratectomy/*methods
Retrospective Studies
Treatment Outcome
Visual Acuity

Figure

• 

  Fig. 1 Pre- and postoperative slit lamp photographs of a patient with band keratopathy who underwent combined ethylene diamine tetraacetic acid chelation, phototherapeutic keratectomy, and permanent amniotic membrane transplantation. (A) Preoperatively, extensive calcium deposition with an irregular surface was detected in the central cornea. (B) Two weeks after surgery, the amniotic membrane was well attached to the cornea. (C) Six months after surgery, the corneal surface was smooth and stable with mild stromal opacity and neovascularization at the inferior cornea.

Reference

1. Chang RI, Ching SS. Krachmer JH, Mannis MJ, Holland EJ, editors. Corneal and conjunctival degenerations. Cornea. 2005. 2nd ed. St. Louis: Mosby;996–997.

2. Barouch FC, Colby K. Foster CS, Azar DT, Dohlman CH, editors. Corneal and conjunctival degenerations. Smolin and Thoft's the cornea: scientific foundations and clinical practice. 2005. 4th ed. Philadelphia: Lippincott Williams & Wilkins;875–877.

3. Najjar DM, Cohen EJ, Rapuano CJ, Laibson PR. EDTA chelation for calcific band keratopathy: results and long-term follow-up. Am J Ophthalmol. 2004. 137:1056–1064.

4. Bokosky JE, Meyer RF, Sugar A. Surgical treatment of calcific band keratopathy. Ophthalmic Surg. 1985. 16:645–647.

5. Wood TO, Walker GG. Treatment of band keratopathy. Am J Ophthalmol. 1975. 80:550.

6. Hersh PS, Klein SR, Wagoner MD. Krachmer JH, Mannis MJ, Holland EJ, editors. Phototherapeutic keratectomy. Cornea. 2005. 2nd ed. St. Louis: Mosby;1735–1748.

7. O'Brart DP, Gartry DS, Lohmann CP, et al. Treatment of band keratopathy by excimer laser phototherapeutic keratectomy: surgical techniques and long term follow up. Br J Ophthalmol. 1993. 77:702–708.

8. Stewart OG, Morrell AJ. Management of band keratopathy with excimer phototherapeutic keratectomy: visual, refractive, and symptomatic outcome. Eye. 2003. 17:233–237.

9. Gartry D, Kerr Muir M, Marshall J. Excimer laser treatment of corneal surface pathology: a laboratory and clinical study. Br J Ophthalmol. 1991. 75:258–269.

10. Moniz N, Fernandez ST. Efficacy of phototherapeutic keratectomy in various superficial corneal pathologies. J Refract Surg. 2003. 19:S243–S246.

11. Kim JC, Tseng SC. Transplantation of preserved human amniotic membrane for surface reconstruction in severely damaged rabbit corneas. Cornea. 1995. 14:473–484.

12. Tseng SC, Prabhasawat P, Lee SH. Amniotic membrane transplantation for conjunctival surface reconstruction. Am J Ophthalmol. 1997. 124:765–774.

13. Azuara-Blanco A, Pillai CT, Dua HS. Amniotic membrane transplantation for ocular surface reconstruction. Br J Ophthalmol. 1999. 83:399–402.

14. Dua HS, Azuara-Blanco A. Amniotic membrane transplantation. Br J Ophthalmol. 1999. 83:748–752.

15. Hori J, Wang M, Kamiya K, et al. Immunological characteristics of amniotic epithelium. Cornea. 2006. 25:S53–S58.

16. Choi YS, Kim JY, Wee WR, Lee JH. Effect of the application of human amniotic membrane on rabbit corneal wound healing after excimer laser photorefractive keratectomy. Cornea. 1998. 17:389–395.

17. Wang MX, Gray TB, Park WC, et al. Reduction in corneal haze and apoptosis by amniotic membrane matrix in excimer laser photoablation in rabbits. J Cataract Refract Surg. 2001. 27:310–319.

18. Anderson DF, Prabhasawat P, Alfonso E, Tseng SC. Amniotic membrane transplantation after the primary surgical management of band keratopathy. Cornea. 2001. 20:354–361.

19. Kwon YS, Song YS, Kim JC. New treatment for band keratopathy: Superficial lamellar keratectomy, EDTA chelation and amniotic membrane transplantation. J Korean Med Sci. 2004. 19:611–615.

20. Baltatzis S, Papaefthimiou J. Treatment of calcific band keratopathy by Nd:YAG laser. Eur J Ophthalmol. 1992. 2:27–29.

21. Maloney RK, Thompson V, Ghiselli G, et al. A prospective multicenter trial of excimer laser phototherapeutic keratectomy for corneal vision loss. Am J Ophthalmol. 1996. 122:149–160.

22. Dogru M, Katakami C, Miyashita M, et al. Ocular surface changes after excimer laser phototherapeutic keratectomy. Ophthalmology. 2000. 107:1144–1152.

23. Hick S, Demers PE, Brunette I, et al. Amniotic membrane transplantation and fibrin glue in the management of corneal ulcers and perforations: a review of 33 cases. Cornea. 2005. 24:369–377.

24. Szurman P, Warga M, Grisanti S, et al. Sutureless amniotic membrane fixation using fibrin glue for ocular surface reconstruction in a rabbit model. Cornea. 2006. 25:460–466.