Dissolve or Evaporate: an Update to Treatment Modalities in Band-like Keratopathy

BACKGROUND: Treatment modalities for band keratopathy (BK), which consists of calcium phosphate deposits in Bowman's layer and upper corneal stromal lamellae, are ethylenediamine tetraacetate (EDTA) chelation and phototherapeutic keratectomy (PTK). In this retrospective study, we compared the effectiveness and the recurrence rate for both methods.

PATIENTS/MATERIAL AND METHODS: We conducted a retrospective study of patients with idiopathic BK who had been treated with EDTA-chelation or PTK and who had no other relevant corneal disease. Of 81 patients, 34 were treated with EDTA chelation and 47 with PTK. Demographic data, comorbidities, pre- and postoperative visual acuity, preoperative severity of the disease and technical surgical parameters were recorded. The results were compared descriptively. A telephone survey was conducted to investigate the subjective outcome after surgery and the development of recurrences.

RESULTS: Regardless of the preoperative severity of BK, treatment intensity and comorbidities, this study confirmed an equal improvement in visual acuity with both EDTA chelation and PTK. The telephone survey showed that the recurrence rate after PTK was significantly lower than after EDTA-chelation (chi-square = 4.74; p = 0.03, n = 25). However, the postoperative symptomatic relief was similar in both groups.

CONCLUSION: EDTA chelation and PTK as treatment of BK provide equivalent improvement in visual acuity and postoperative symptomatic relief. A lower recurrence rate may be expected with PTK. Further prospective studies would be necessary to confirm our results.