PHOTOTHERAPHEUTIC KERATECTOMY FOR CALCIFIC BAND KERATOPATHY SECONDARY TO MULTIPLE MYELOMA

To report a case of calcific band keratopathy (CBK) secondary to multiple myeloma successfully treated with phototherapeutic keratectomy (PTK).

Despite rare, CBK may be associated with systemic conditions such as multiple myeloma. CBK could dramatically impair visual acuity and surgery is recommended when medical therapy fails. PTK is one of surgical modalities of choice and could provide substantial visual recovery. Follow-up was conducted by Department of Ophthalmology, Hospital Garcia de Orta E.P.E

An 80-year-old woman presented with progressive vision loss in her left eye. Ophthalmological history was positive for cataract surgery in both eyes. Best corrected visual acuity (BCVA) was 0.4 LogMAR. Slit-lamp examination revealed a central band-like corneal opacification, suggestive of calcific band keratopathy. Anterior segment optical coherence tomography (AS-OCT) showed a subepithelial hyperreflective layer. Etiologic investigation revealed an indolent Multiple Myeloma IgAk with no clinical indication for systemic therapy. After adequate de-epithelialization, PTK was performed using the Technolasâ TENEOä 317 M2 excimer laser. The optical treatment zone was set to 7.0 mm, the ablation depth was set to 40μm based on AS-OCT findings, and balanced salt solution was used as masking agent, with resulting corneal surface regularization and BCVA improvement. Patient was followed at 1 week, 6 months and 1 year post operatively. At 1-year follow-up the patient was completely asymptomatic, with clear cornea, normal topography, and no hyperreflectivity band on AS-OCT. BCVA was 0.00 LogMAR with +1.50 -1.75 x 100º.

CBK may be associated with systemic conditions which should be ruled out. PTK is an effective and safe procedure in the management of CBK, providing fully visual rehabilitation in a great number of cases.