Queratectomía fototerapéutica en la queratopatía en banda / Phototherapeutic keratectomy in the band keratopathy

Las opciones quirúrgicas con la utilización del láser excímer en determinadas entidades corneales reporta importantes beneficios. La queratopatía en banda, considerada como una degeneración de la córnea superficial caracterizada por la presencia de depósitos de calcio en la membrana de Bowman, es una de las afecciones corneales que han mostrado alentadores resultados con la realización de la queratectomía fototerapéutica. Se presenta un paciente de 68 años, del sexo femenino y piel blanca, con antecedentes de uveítis anterior. En la consulta refirió sensación de cuerpo extraño del ojo derecho. En la exploración oftalmológica del ojo derecho se apreciaron en la córnea superficial depósitos de color blanco-grisáceo de localización interpalpebral. Los estudios refractivos realizados constataron una disminución marcada de la agudeza visual de cuenta dedos en ambos ojos. Se le realizó queratectomía fototerapéutica del ojo derecho y mejoró la sintomatología ocular(AU)

The surgical options with the use of the excímer laser in certain corneal diseases provide important benefits. Band keratopahy, considered a superficial corneal degeneration characterized by the presence of calcific bands in Bowman's membrane, is one of the corneal affections that have shown encouraging results with the performance of phototherapeutic keratectomy. Here is a 68 years-old Caucasian female with no history of previous uveitis. At the ophthalmological service, she said she felt some foreign body in her right eye. The eye examination revealed white-gray superficial deposits of intereyelid location in the cornea. The refractive studies confirmed a marked reduction of visual acuity in both eyes. The patient underwent phototherapeutic keratectomy and her ocular symptoms improved(AU)

Pars Planitis en la infancia / Pars Planitis in childhood

Objetivo: Evaluar la respuesta al tratamiento con corticoides e inmunomoduladores en niños con pars planitis. Materiales y método: Se realiza un estudio retrospectivo y observacional de nueve historias clínicas de pacientes con diagnóstico de pars planitis atendidos en el servicio de oftalmología del Hospital de Pediatría Juan P. Garrahan desde el año 2010. Resultados: De los nueve pacientes 6 eran niños y 3 niñas. El motivo de consulta principal fue disminución de la visión. La mayoría de los pacientes fueron derivados por otros oftalmólogos para tratamiento. El 100% sufrió afectación ocular bilateral. Las complicaciones fueron: catarata, queratopatía en banda, hipertensión ocular y edema macular cistoide. El 100% de los pacientes recibió tratamiento con corticoides por vía oral e inmunomoduladores. A algunos se les efectuó inyecciones de triamcinolona subtenoniana y criocoagulación. Conclusiones: con el tratamiento con prednisona e inmunomoduladores se logró mejoría en la agudeza visual en 15 ojos y 3 ojos mantuvieron igual agudeza visual. La pars planitis es una patología crónica con un pronóstico visual reservado que requiere de un seguimiento estrecho y tratamiento prolongado por parte de un equipo interdisciplinario (AU)

Objective: To assess response to steroid and immunomodulating treatment in children with pars planitis. Material and methods: A retrospective observational study was conducted reviewing nine clinical charts of children with a diagnosis of pars planitis seen at the Department of Ophthalmology of the Pediatric Hospital Juan P. Garrahan since 2010. Results: Of nine patients, six were boys and three were girls. Main complaint was loss of vision. The majority of patients were referred to our hospital by other ophthalmologists for treatment. All children had bilateral eye involvement. Complications observed were: cataracts, band keratopathy, ocular hypertension, and cystoid macular edema. All patients received oral steroids and immunomodulating treatment. In some subtenonian injection of triamcinolone and cryocoagulation was performed. Conclusions: Prednisone and immunomodulating treatment resulted in an improvement of visual acuity in 15 eyes and three eyes visual acuity remained unchanged. Pars planitis is a chronic disease with an uncertain visual prognosis that requires close follow-up and prolonged treatment by an interdisciplinary team (AU)

Cosmetic Repair of Band Keratopathy Using Stained Amniotic Membrane

PURPOSE: To evaluate the efficacy of stained amniotic membrane transplantation (AMT) for cosmetic repair of band keratopathy. METHODS: Eight eyes from 8 patients with band keratopathy without the possibility of visual improvement were treated with corneal tattooing and stained AMT. Calcific plaques were removed with EDTA and a blade prior to the tattooing. Tattooing by the injection of tissue marking dye into the corneal stroma was performed in corneal opacities. The remaining opacity, which could not be treated with corneal tattooing, was treated with black dye-stained AMT. RESULTS: The most common cause of band keratopathy was trauma (50%) and the mean time to epithelial healing was 11.3 days. All patients showed satisfactory results with cosmetic staining. Recurring cases and significant complications were not observed during the mean follow-up period of 7.4 months. CONCLUSIONS: Cosmetic repair by corneal tattooing and stained AMT is an effective treatment for band keratopathy and is not associated with any significant complications.

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

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.

A case of Primary Band Keratopathy Treated by EDTA Application in Patient with Hyperparathyroidism

PURPOSE: We report a case of band keratopathy caused by hyperparathyroidism which was treated using EDTA (disodium ethylenediaminetetraacetic acid). METHODS: A 33-year-old woman with band keratopathy caused by hyperparathyroidism with elevated serum calcium, without any eye abnormalities was seen at Korea university hospital. Her corneal epithelium was removed after topical anesthesia, and the lesion was exposed by chemical chelating agent of 0.02M EDTA for 10 minutes, then, dropped topically every 30 seconds, the grayish white opacity which presents the calcium deposits was removed by chemical chelation of 0.02M EDTA in cornea. RESULTS: Most of the opacity was disappeared by chemical chelation with improvement of vision by 4 lines from 10/100 to 10/20. Cosmeticity was improved dramatically as well. No recurrence of corneal opacity was observed at 14 months after the operation. CONCLUSIONS: We experienced one case of band keratopathy caused by only hyperparathyroidism with hypercalcemia, without chronic uveitis, glaucoma, corneal edema, recurrent trauma any eye abnormalities. The primary band keratopathy was successfully treated by chemical chelation of EDTA : visual acuity was improved, foreign body sensation was relieved, and good cosmetic results were achieved. To our best knowledge, this is the first case of primary band keratopathy with hyperparathyroidism with hypercalcemia without any eye abnormalities, and we successfully treated by chemical chelation of EDTA.

The Efficacy of EDTA Chelation on Band Keratopathy

We used chemical chelation of EDTA(disodium ethylenediaminetetraacetic acid) to remove calcium hydroxyapatite in the Bowmans layer of band keratopathy and assessed the efficacy in reduction of corneal opacity, relief of ocular discomfort, improvement of visual outcome and prevention of recurrence. A series of 12 eyes with band keratopathy was treated by chemical chelation of EDTA, with a mean follow up period of 8.5 months (range 6 to 15 months). After topical anesthetic instillation, the epithelium should first be removed. The EDTA is then applied repeatedly in a saturated cellulose sponge of 0.05mol solution for 10 minutes. Thereafter the corneal surface is scraped with spatula until the gritty sensation disappears. After calcium removal, the eye was patched for a while to allow the epithelium to heal with the daily use of topical antibiotics. The complete recovery of corneal clarity was observed in 4 eyes and slight corneal opacity remained in 12 eyes. Mild foreign body sensation persisted in 1 eye. Increased visual outcome by 2 lines was observed in 3 eyes. The corneal epithelium healing was completed within 3 days in 10 eyes. Recurrent corneal erosions was observed in 2 eyes but disappeared within 3 weeks by appropriate treatment. No recurrence was observed. We recommend a chemical chelation of EDTA to treat band keratopathy as a primary method in virtue of its simplicity, effectiveness and safety.