Bilateral Recurrent Calcareous Degeneration of the Cornea

Messmer, Elisabeth M.; Hoops, Jan P.

doi:10.1097/01.ico.0000151559.32613.0b

Cited by 10 publications

(6 citation statements)

References 26 publications

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“…[14][15][16] In these settings, calcium deposition may occur because of an increase in the local concentration of calcium or phosphorus, an increase in pH, or an alteration in tear osmolality. 11,17,18 Because the individuals whom we report did not have a history of ocular surface inflammation, chronic use of topical ocular medications, ocular injury or surgery (other than LASIK), or elevated serum calcium levels, we believe that another condition likely led to an alteration in the corneal calcium or phosphorous level, the corneal pH, or the tear osmolarity, leading to a local increase in ionized calcium and subsequent deposition.…”

Section: Discussionmentioning

confidence: 96%

“…Although we are not able to determine the mechanism through which calcium deposited in the LASIK flap interface in the cases that we report, it is likely through one of the previously described mechanisms by which calcium deposits on the cornea. Superficial calcific corneal deposition has been associated with a variety of etiologies, including ocular surface inflammation, the use of various topical and intracameral medications, [6][7][8] ocular injury, 9 corneal, 10,11 or other ocular surgeries, 12,13 and systemic diseases affecting calcium metabolism. [14][15][16] In these settings, calcium deposition may occur because of an increase in the local concentration of calcium or phosphorus, an increase in pH, or an alteration in tear osmolality.…”

Section: Discussionmentioning

confidence: 99%

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Late Onset Interface Calcium Deposition After Laser In Situ Keratomileusis

Chen¹,

Pelsor

Wang

et al. 2021

Cornea

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The purpose of this study was to report a novel clinical entity characterized by bilateral calcium deposits in the flap interface after uncomplicated laser in situ keratomileusis (LASIK).Methods: Slit-lamp examination, anterior segment optical coherence tomography imaging, and histopathologic analysis of an interface opacity were performed to characterize and identify the origin of the interface opacities.Results: Two unrelated healthy young men who underwent LASIK in both eyes at 20 (case 1) and 44 (case 2) years of age were diagnosed with bilateral, white anterior stromal opacities 5 years after LASIK surgery. Slit-lamp examination and anterior segment optical coherence tomography imaging demonstrated that the opacities were located at the level of the LASIK interface in both eyes of both cases, with most of the opacities located at the temporal edge of the flap in each eye of case 2. An opacity from case 2 demonstrated birefringence using polarization microscopy and staining with Alizarin red, indicative of calcium deposition. The serum calcium level was borderline elevated in case 1 and within normal limits in case 2.Conclusions: Intrastromal calcium deposition can occur after LASIK surgery, with the deposits resembling dystrophic deposits located in the LASIK flap interface in individuals with granular corneal dystrophy type 2. Because the etiology and management of calcific and dystrophic interface deposition after LASIK are distinct, it is important for clinicians to differentiate the 2 entities based on the examination, diagnostic imaging, and, if necessary, molecular genetic analysis.

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Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

Late Onset Interface Calcium Deposition After Laser In Situ Keratomileusis

Chen¹,

Pelsor

Wang

et al. 2021

Cornea

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“…Rapid calcification can extend deeply into the stroma, differing from band keratopathy [1,[5][6][7]. Continuous use of betamethasone sodium phosphate in the presence of an epithelial defect can cause rapid stromal calcification [2,8,9].…”

Section: Discussionmentioning

confidence: 99%

Rapid Corneal Calcification Following Endothelial Keratoplasty: A Case Report

Fukuto,

Shinji,

Deie

et al. 2024

Cureus

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Corneal calcification typically progresses slowly but can occasionally advance rapidly. This report details severe stromal calcification following repeat Descemet's stripping automated endothelial keratoplasty (DSAEK) in a 75-year-old patient with diabetes, hypertension, and prior ocular surgeries, including cataract surgery, intraocular lens extraction with suturing, and trabeculectomy. Persistent epithelial defects after the surgery led to rapid central stromal calcification within four weeks, significantly reducing visual acuity. Management included switching from betamethasone sodium phosphate to fluorometholone, facilitating complete epithelial recovery within two months. However, persistent stromal opacity necessitated a subsequent penetrating keratoplasty. Infrared absorption spectrophotometry identified calcium phosphate as the primary component of the calcification. This case highlights the importance of vigilant monitoring and proactive management of epithelial defects to prevent rapid calcification following endothelial keratoplasty.

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“…Although the typical slit lamp appearance of the corneal features makes easy clinical diagnosis, histopathologic examination remains the gold standard for definitive diagnosis, being able to offer a detailed microscopic analysis of the tissue. Despite the exact pathogenesis of the more profound form of calcium deposition not being fully understood, conservative and surgical treatment options have been proposed for its management [1][2][3][4][18][19][20][21][22][23].…”

Section: Introductionmentioning

confidence: 99%

Management of Calcareous Corneal Degeneration from Medication Washout to Corneal Transplantation. Case Series and Review of the Literature

Lixi,

Pintus,

Giannaccare

2024

OBM Transplant

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Calcareous corneal degeneration is a rare disease characterized by calcium phosphate deposition into the deep corneal layers. Corneal calcification has a multifactorial origin and is associated with various systemic and ocular conditions. Several treatment options showed promising results in the management of this disorder. Herein, two cases of calcareous degeneration occurring postoperatively in patients undergoing surgery for retinal detachment (case #1) and glaucoma (case #2) were reported. Despite normal serum calcium and phosphate levels, the patients developed corneal calcification after using topical steroid-phosphate drops. Treatment involved discontinuation of topical therapy and substitution with unpreserved phosphate-free lubricants. While case #1 resolved with conservative measures, which allowed a satisfactory visual recovery, case #2 required superficial keratectomy due to refractory calcification. Therefore, a correct diagnosis, careful lesion analysis, and tailored management are advisable in corneal calcification, with conservative measures being effective in most cases. At the same time, surgical intervention is necessary in refractory or advanced diseases.

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Bilateral Recurrent Calcareous Degeneration of the Cornea

Abstract: Keratoconjunctivitis sicca, epithelial defects, corneal inflammation, and infection are most probably responsible for the recurrent pancorneal calcification seen in our patient. The role of cytokines in this complication is discussed.

Cited by 10 publications

References 26 publications

Late Onset Interface Calcium Deposition After Laser In Situ Keratomileusis

Late Onset Interface Calcium Deposition After Laser In Situ Keratomileusis

Rapid Corneal Calcification Following Endothelial Keratoplasty: A Case Report

Management of Calcareous Corneal Degeneration from Medication Washout to Corneal Transplantation. Case Series and Review of the Literature

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