Band Keratopathy EDTA chelation (Video)

This video shows an eye with significant cornea band keratopathy, and how it is removed with EDTA chelation.

About this condition
Band Keratopathy, is a precipitation of calcium salts that forms under the epithelium. It occurs in a band pattern across the middle cornea that is most exposed to air. The believe is that evaporation of tears allows calcium and phosphate to increase in concentration and precipitate in this intrapalpebral space.

Now … why doesn’t EVERYONE get band keratopathy? We believe that elevation of the surface pH level, which occurs with conditions such as chronic inflammation, may change the calcium solubility and lead to high rates of precipitation. This theory is supported by the fact that these calcium bands don’t go all the way to the limbus because the limbal blood circulation here has a buffering effect on pH.

On exam, you can see a layer of white material or plaques at the level of bowmans layer and even in the anterior stroma. You can sometimes see small round holes in this plaque which are where corneal nerves break through bowman’s membrane on their way up to the epithelium.

If sparse, band keratopathy may go unnoticed by the patient. However, with extensive deposition in the visual axis, acuity can be affected. Also, epithelial cells don’t stick down well to calcium plaques and these patients can have recurrent corneal erosions and discomfort. Vision and comfort are both reasons to consider a surgery.

Debridement:
Calcium can be removed (like in this video) in a minor procedure room. After anesthetizing the eye, the cornea is bathed with 2% EDTA solution. This solution can be applied using Weck-cel sponges or by using a funnel to bath the cornea. The surface epithelium and underlying calcium is than scraped off using a blunt spatula or careful application of a curved scalpel. Small deposits remove easily, but larger plaques can be tenacious requiring 30 minutes or more of additional chelation/scraping. The goal is to clear the central visual axis.

An excimer laser can be used to polish the underlying cornea if significant irregularities exist. However, you definitely DON’T want to use that laser to remove the calcium … the laser will preferentially remove stroma and you’ll end up with significant irregular astigmatism.

Potential Ocular Associations with Band Keratopathy

  • Chronic Uveitis
  • JRA
  • Phtisis
  • End stage glaucoma
  • Topical steroid (with phosphate)
  • Pilocarpine with mercury based preservatives
  • Silicone Oil
  • Intraocular tPA

If a patient presents to you with no signs of ocular cause, consider drawing a serum calcium, phosphate, parathyroid, and sarcoid labs (ACE, lysosyme).

Systemic diseases associated with high calcium

  • Paget disease
  • Hyperparathyroidism
  • Vitamin D excess
  • Kidney Failure
  • Sarcoidosis
  • High Phosphate

Download this video

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bandkeratopathy.wmv (9.0 meg, Windows video file)

Thumbnails (click to enlarge photo)

Band Keratopathy
The calcium deposits tend to form in a band that corresponds to the palpebral fissure. Dehydration along this area causes the increased calcium precipitation.
Corneal calcium
Calcium forms underneath the surface of the epithelium in bowman’s layer.
Slit beam cornea
You can tell that the deposits are relatively superficial because the anterior portion of the slit-beam lights up.
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Dr. Timothy Root is a practicing ophthalmologist and cataract surgeon in Daytona Beach, Florida. His books, video lectures, and training resources can be found at:

25 COMMENTS

  1. I am an Ophthalmic Tech. and saw a band keratopathy in one of our patients today so I decided to look it up on line and found your website. I love it and have bookmarked it for future reference. Thank you for a most interesting and informative website.
    Susan

  2. I’m a pharmacist and I had a couple of questions about the EDTA you are using. Is this a sterile product or are you using a non-sterile research grade EDTA solution? Also, are you purchasing this as a 2% solution or is it being diluted at your facility with something isotonic to the eye (like BSS)?

  3. Dear sir,

    Thank you very much for giving this excellent information.2 years ago I had this EDTA treatment in The netherlans and had a terrible post operative pain for 3 days.My doctor told me there is no way to anestesize the pain.Next week I will have a new treatment.Can you help me ?

    sincerely,

    Wytse Mellema

  4. Hey, Tim! Wow this site is AMAZING! Thanks for helping all the pictures we see in books come to life, its obvious you put a lot of work into this and just want to let you know your efforts are greatly appreciated!

    – Dr. Roy

  5. I am an OR nurse and have not seen this procedure. I decided to research it before the start of the case for information and came across your site. It was excellent. Thank you

    J. Lang, RN

  6. I like the procedure. Where I can get the 2% EDTA sterile solutions.I have seen doctors are using in Kim’s eye Hospital, Seoul, Korea. We have many patients in Bangladesh. Can you suggest how I can have the EDTA solution?
    Dr.Mamun

  7. Could you give me the formula for EDTA 2% or where it can be purchased. Is it a sterile solution and if so did you autoclave it?
    Thanks
    Vicki

  8. I HAVE A PATIENT WITH BAND KERATOPATHY BILATERAL.HE HAS PAIN ONLY TO THE LEFT EYE AND HE HAS NOT DECREASED OF VISION.SHOULD I TREAT HIM WITH EDTA?T PLANO WOULD HELP IN THIS CASE?

  9. I HAVE A PATIENT WITH BAND KERATOPATHY BILATERAL.HE HAS PAIN ONLY TO THE LEFT EYE AND HE HAS NOT DECREASE OF VISION.SHOULD I TREAT HIM WITH EDTA?T PLANO WOULD HELP IN THIS CASE?

  10. Hello, this site may be only for professionals? But may I ask about my Band Keratopathy please?

    Six months ago I had a cataract surgery. My surgeon also scraped a corneal keratopathy in the same eye (though it never bothered me before). Now my vision is blurred and have a scratching-like feeling and other discomforts everyday which forces me to keep this eye closed for relief. Before the surgery this eye only bothered me once in a while. The surgeon told me “It will never get better”.

    I’m in the process of obtaining a 2nd opinion so I’m trying to find a corneal specialist in NYC Manhattan who could deal with this case, and who hopefully carries my Emblem Health PPO too. 🙂

    Meantime, could a kind soul here tell me what usually happens in cases like mine? I’m SO hoping to find a cure for this failed treatment! Thanks so very much!

    Rosedala (I’m a female, in my 80s and in perfect health…)

  11. I’ve had this procedure performed three times and the calcium keeps returning. Does anyone have any idea how I can prevent this from happening. It’s very discouraging and I’m reluctant to have procedure performed again. Does anyone know of any new procedures being performed to remove the calcium from the cornea. Thank you.

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