EDTA Chelation for Band Keratopathy
Andrew R. Lee, MD
PREOPERATIVE CONSIDERATIONS
Chronic inflammatory ocular disease (uveitis, keratitis, phthisis bulbi).
Topical medications containing mercury or phosphates (eg, some steroid preparations, pilocarpine).
Hypercalcemia.
Silicone oil.
Hereditary (primary hereditary band keratopathy, Norrie disease, CHED).
Indications for ethylenediaminetetraacetic acid (EDTA) chelation for band keratopathy:
Visually significant band keratopathy.
Pain not controlled with more conservative measures such as lubrication.
Mechanism of action:
EDTA is a metal ion chelator that can help dissolve the calcium present at the level of Bowman membrane in band keratopathy.
If the etiology of the band keratopathy is unknown, serum electrolytes and urinalysis may be performed to assess for metabolic or renal disease. Parathyroid hormone, angiotensin converting enzyme, and assessment for lytic bone lesions can also be considered.4
Surgical planning:
Preoperative examination:
Assess for any ocular surface disease that may impair epithelial healing postoperatively (dry eye, limbal stem cell deficiency, neurotrophic keratopathy).2
If performing surgery to improve vision, assess for any other ocular pathology that may limit visual potential (retinal disease, optic neuropathy, glaucoma).
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