EDTA chelation for symptomatic band keratopathy: results and recurrence

Abstract

PurposeTo identify causes of symptomatic band keratopathy, and assess the results and long-term recurrence rates following chelation with topical ethylene-diamine-tetra-acetic acid (EDTA).Patients and methodsA retrospective review of surgical logbooks identified patients managed by EDTA chelation for symptomatic band keratopathy from 2009 to 2015.ResultsWe identified 108 cases; 89 case notes were available for analysis. Most cases of band keratopathy were idiopathic (36%). The most commonly identified underlying diagnosis was long-term topical glaucoma therapy (27%). Median presenting visual acuity was 6/18 (range 6/6-NPL) with the visual axis affected in 97.8% of cases. Treatment involved corneal epithelium removal, recurrent application of topical EDTA, and subsequent debridement. The mean duration of the operation was 20 min (range 10-45). Mean initial follow-up time was 40 days, and the visual axis was clear in 97.8%. Visual acuity was maintained or improved in 79.8%, with 13.5% improving by two lines or more. The mean length of follow-up was 581 days (median 374, maximum 2438). Twenty-five eyes (28.1%) showed localised recurrence of calcium with a mean time of 546 days (median 374), but only four cases required repeat EDTA chelation. The median time between operations was 430 days. Thirty-two per cent of the recurrence cases were associated with hypotony or chronic presence of silicone oil.ConclusionsChelation of calcium with topical EDTA is a safe and effective treatment for band keratopathy. Visual acuity improves in most eyes and while the rate of recurrence is moderate, the need for retreatment is low (4.5% overall).

Removal of calcific band keratopathy without ethylenediaminetetraacetic acid (EDTA) in eyes with limited visual potential

“…This figure is in line with a recent series that described recurrence in 28% of patients after chelation with EDTA. 7 The recurrence interval in our small series treated without EDTA (4 and 28 months) was also grossly similar to the recurrence interval in the large series of patients treated with EDTA (19 months). 7 Our practice is to counsel all patients preoperatively that CBK is likely to recur and may require periodic retreatment.…”

Ethylenediaminetetraacetic Acid Chelation for Band Keratopathy before Ab Interno Glaucoma Surgery

“…In this case, clear visualization of the angle structures was acquired by EDTA chelation. Chelation of calcium with topical EDTA is a safe and reliable method for removing band keratopathy with a low retreatment rate [2].…”

“…Although the combined cataract and minimally invasive glaucoma surgeries (MIGS) was an appropriate surgical option, the presence of band keratopathy (Figure 1(a)) made it difficult to perform ab interno glaucoma surgery OD; therefore, the corneal opacity was removed using ethylenediaminetetraacetic acid (EDTA) chelation procedure. The procedure involved corneal epithelium removal and subsequent debridement with a sponge (M.Q.A., Inami, Tokyo, Japan) soaked with 0.05 mol/l EDTA [2]. One month after chelation, microhook ab interno trabeculotomy and cataract surgery [3] [4] were performed (Figure 1(b)).…”

BCLA CLEAR – Medical use of contact lenses

“…In this small cohort, the BSCL was very effective in reducing postoperative pain. A retrospective study evaluated 89 cases that were all fitted with a BSCL postop and focused on the recurrence of disease; however, no mention of the BSCL type or impact of the BSCL on procedural outcomes or ocular discomfort were noted [134].…”