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Sat Oct 08, 2011 3:25 am

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Joined: Fri Apr 27, 2007 4:18 am
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Age: 34
Location: Bay Area, CA

Hello,

I was wondering, does anyone here have any information or anecdotal stories of how band keratopathy interacts with a scleral shell? I have visited two opthamologists and they both confirm that I have it over my right eye. I am presuming this is from using pilocarpiane for a long part of my life. They said this could be a cause why I have had so many problems wearing a scleral shell. Thanks for any insight.

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Sat Oct 08, 2011 3:34 am

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Also, could using lubricants like ocu-glide and ocu-sil cause calcium build up?

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Sat Oct 08, 2011 3:43 am

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Joined: Sat Jun 28, 2008 9:28 pm
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Age: 79
Location: Near Vancouver B.C.

Hello,
Janelle and myself have both had calcium band keratopathy. For me just the pain from that itself would prohibit the wearing of a scleral shell. Janelle now has a prosthesis and I have had a cornea transplant.
Hope you find an answer,
Best wishes,
Maureen

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Sat Oct 08, 2011 8:45 pm

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Joined: Sat Aug 06, 2011 1:53 am
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Location: tampa, florida, usa

jeffmor:

as you probably already know, band keratopathy is an ocular condition where calcium salts are deposited under the corneal epithelium (outer layer). unfortunately, the corneal nerve endings can still make their way through and around the calcium band(s) and to the surface of the cornea. the calcium band can sometime break down leaving exposed nerves. some band keratopathy patients can tolerate a scleral shell and others cannot. it depends on the extent of the band and the sensitivity of the nerves. not only are there ocular causes of band keratopathy but there are also some systemic diseases and conditions that can make a person prone to developing a band keratopathy. as you mentioned chronic use of pilocarpine or other chemical irritants has been shown to cause calcium deposits in the cornea. dry eye syndrome and other chronic ocular inflammations can stimulate calcium deposits. medical conditions that cause increased serum calcium levels such as multiple myeloma or hyperparathyroidism can also cause band keratopathy. i will assume that your ophthalmologists have already discussed the few treatments that are available in an attempt to remove the band. good luck.



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Sun Oct 09, 2011 3:39 am

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Joined: Fri Apr 27, 2007 4:18 am
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Location: Bay Area, CA

cslonim wrote:
jeffmor:

as you probably already know, band keratopathy is an ocular condition where calcium salts are deposited under the corneal epithelium (outer layer). unfortunately, the corneal nerve endings can still make their way through and around the calcium band(s) and to the surface of the cornea. the calcium band can sometime break down leaving exposed nerves. some band keratopathy patients can tolerate a scleral shell and others cannot. it depends on the extent of the band and the sensitivity of the nerves. not only are there ocular causes of band keratopathy but there are also some systemic diseases and conditions that can make a person prone to developing a band keratopathy. as you mentioned chronic use of pilocarpine or other chemical irritants has been shown to cause calcium deposits in the cornea. dry eye syndrome and other chronic ocular inflammations can stimulate calcium deposits. medical conditions that cause increased serum calcium levels such as multiple myeloma or hyperparathyroidism can also cause band keratopathy. i will assume that your ophthalmologists have already discussed the few treatments that are available in an attempt to remove the band. good luck.


Ok, thanks cslonim, that was very informative. It sounds as if pain from wearing a scleral shell is being caused by exposed corneal nerves, which may be exposed by the band keratopathy. What is the way to reduce that pain? Will removal of the keratopathy expose even more nerves, or does something get placed over the eye after the surgery? I haven't had this discussion with my opthamologist yet...she's going to give me a referral to a specialist if I want it. I just wanted to talk about it here first.

Also, do silicone based lubricants cause band keratopathy?

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Sun Oct 09, 2011 4:15 am

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Hi Jeff,
I had band keratopathy and there is no way I could have worn a shell but as cslonim said some people can.

I did have my calcium cleaned off twice and from what my cornea doctor said some people have to have it regularly cleaned off. I was not able to have it cleaned off again as my eye continued to shrink and it was just time to have it removed.

The calcium cleaning wasn't that bad. They cleaned it in surgery with twilight sleep anethesia. It took 15 minutes or so and then I went home to rest my eye for the rest of the day. The next day I was fine and went to work. The difference after the cleanup was fantastic. I had about 5 months of no pain and then the calcium came back. It might be something you may what to check out.

As Maureen said cornea transplant could be another option to get rid of the pain (not for me as my eye wasn't healthy enough) but maybe not if you want to wear a shell. My doctor also mentioned sewing some type of material over my cornea but again my eye just couldn't take any other surgeries. I can't remember what the material was but ask your doctor what options might work in your case.

Best wishes, Janelle

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Sun Oct 09, 2011 2:28 pm

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Location: tampa, florida, usa

jeffmor:

janelle posted a great response. i will only add that the"material" that is sometime used to cover the cornea after the calcium is removed is the conjunctiva. the conjunctiva is loosened from around the outside edge of the cornea and stretched over the defect (abrasion) that is left when the caclium is removed. the more calcium that is removed or the more times it is removed, the thinner the center of the cornea becomes (as janelle described hers). when the conjunctiva is placed over the cornea, the cornea will lose its clarity (permanently). amniotic membrane has also been used as a "scaffold" which allows the normal corneal cells (clear ones not cloudy like the conjunctiva) to grow over it and try to establish a clear central cornea. amniotic membrane is harvested from the amniotic sacs of newborn babies. these treatments address the calcium that exists on the cornea at the time of surgery. it does not prevent future deposits.



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