to report a case of visually significant band keratopathy associated with ocular inflammation and systemic hypercalcemia which markedly decreased in severity after treatment of these underlying factors .
a 53-year - old asian female with granulomatous panuveitis in the left eye presented with diffuse band keratopathy through the central cornea . the serum calcium was elevated .
the patient was treated with topical prednisolone acetate 1% and oral prednisone with marked improvement in inflammation . the band keratopathy lessened in severity with clearing of the central cornea and improvement in visual acuity .
the term band keratopathy describes the precipitation of calcium salts in bowman s layer in a band - like distribution across the central cornea .
there are several local and systemic causes of band keratopathy , the most common ocular condition being intraocular inflammation and the most common systemic condition being hypercalcemia ( najjar et al 2004 ) treatment of symptomatic band keratopathy is typically surgical ; treatment of the underlying cause can prevent further calcium deposition but does not usually reverse the corneal findings . we herein report a case of band keratopathy associated with ocular inflammation and systemic hypercalcemia , which markedly improved after treatment of the underlying factors .
a 53-year - old asian female presented with intermittent pain and decreased vision in the left eye .
her past ocular history was significant for retinal detachment repair in the right eye five months prior .
she reported a slow visual decline in her left eye starting six weeks after the surgery on her right eye .
her past medical history was significant for chronic active interstitial pneumonitis diagnosed by lung biopsy four years prior , rheumatoid arthritis , hypothyroidism , and a recent diagnosis of hypercalcemia ( 12.7 mg / dl ) believed to be secondary to excessive calcium intake . on presentation , visual acuity was 9/200 in the right eye and 20/100 in the left eye .
slit - lamp examination revealed a cataract in the right eye without uveitis ; the left eye had diffuse band keratopathy through the central cornea ( figure 1 ) , prominent mutton - fat keratic precipitates , 1 + anterior chamber cell , and 2 + vitritis .
dilated funduscopic examination revealed a cup - to - disc ratio of 0.3 in both eyes with peripapillary atrophy .
the view into the left eye was hazy due to band keratopathy and vitritis but the retina appeared flat with no areas of vasculitis or choroiditis .
a work up was obtained including a fluorescent treponemal antibody ( fta ) , rapid plasma regain ( rpr ) , human leukocyte antigen b27 ( hlab27 ) , and chest imaging but was unrevealing as to the etiology of the uveitis .
a lung biopsy was consistent with chronic active interstitial pneumonitis ; there was no evidence of sarcoidosis on biopsy .
the patient returned two months later and reported an improvement in visual acuity and resolution of ocular discomfort .
medications included prednisolone acetate 1% five times daily to the left eye and prednisone 10 mg per day , which had been initiated by the patient s primary care physician 2 weeks prior due to shortness of breath .
visual acuity was 7/200 in the right eye and 20/35 in the left eye . slit lamp examination was significant for new mild , peripheral band keratopathy in the right eye and improving band keratopathy in the left eye .
there was trace anterior chamber inflammation in the right eye and 1 + vitritis in the left eye .
dilated funduscopic examination of the left eye revealed inactive - appearing chorioretinal lesions along the superotemporal and inferotemporal arcades .
topical prednisolone acetate 1% was slowly tapered in the left eye ; no local therapy was instituted in the right eye as the patient was asymptomatic and vision was stable .
the patient returned two months and reported further improvement in vision in the left eye .
medications included prednisolone acetate 1% once daily in the left eye and prednisone 10 mg daily .
slit lamp examination was significant for stable band keratopathy in the right eye and a marked improvement in band keratopathy ( figure 2 ) in the left eye .
we herein describe a case of transient band keratopathy associated with ocular inflammation and mild systemic hypercalcemia .
although it is unclear which of the two factors was responsible for the band formation , we postulate that the ocular inflammation played a more dominant role as the uveitis was more severe and the systemic hypercalcemia was relatively mild .
in addition , the time course of the band development closely mirrored that of the ocular inflammation .
specifically , band keratopathy was noted in the right eye in the setting of ocular inflammation and normalizing calcium levels .
clearing of the left central cornea occurred 4 months after treatment of ocular inflammation and normalization of serum calcium .
transient band keratopathy has been described in patients with systemic hypercalcemia due to renal failure ( feist et al 1992 ) , sarcoidosis ( johnston et al 1995 ) , and pituitary adenoma ( alonso santiago and ramirez fe 2002 ) in the first two cases , the serum calcium level was higher than that found in our patient ( 18 mg / dl and 14.2 mg / dl , respectively ) . a mild anterior uveitis was noted in the patient with transient band keratopathy associated with sarcoidosis . the calcium level in the patient with a pituitary adenoma ( alonso santiago and ramirez fe 2002 ) was similar to that of our patient ( 12.2 mg / dl ) . in summary , we present a case of transient band keratopathy associated with moderate ocular inflammation and mild hypercalcemia .
this case suggests that early and aggressive treatment of the inflammation may result in reversal of band keratopathy .
chelation of band keratopathy should be deferred until an adequate course of anti - inflammatory therapy has been undertaken .
 purposeto report a case of visually significant band keratopathy associated with ocular inflammation and systemic hypercalcemia which markedly decreased in severity after treatment of these underlying factors.methodsretrospective case report.resultsa 53-year - old asian female with granulomatous panuveitis in the left eye presented with diffuse band keratopathy through the central cornea . 
 the serum calcium was elevated . 
 the patient was treated with topical prednisolone acetate 1% and oral prednisone with marked improvement in inflammation . 
 the band keratopathy lessened in severity with clearing of the central cornea and improvement in visual acuity.conclusionsearly medical treatment of underlying factors may allow reversal of band keratopathy . 
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