CORNEAL STROMAL CALCIFICATION FOLLOWING TOPICAL STEROID-PHOSPHATE THERAPY

97th DOG Annual Meeting 1999

P69
CORNEAL STROMAL CALCIFICATION FOLLOWING TOPICAL STEROID-PHOSPHATE THERAPY

U. Schlötzer-Schrehardt, Z. Zagórski, L. M. Holbach, C. Rummelt

Previous reports have described the development of band keratopathy after the use of various drugs including topical steroid-phosphate preparations. We report on a patient with unusual, hitherto not reported secondary calcification of the corneal stroma following long-term topical steroid-phosphate therapy.

Case report: A 39-year-old woman was treated for chronic kerato-conjunctivitis after Stevens-Johnson syndrome with dexametha-sone-phosphate drops for several years. She developed recurrent corneal erosions and dense vascularized corneal scars requiring penetrating keratoplasty LE. The patient's serum levels of calcium and phosphorus were normal.

Results: Histopathologic and electron microscopic examination of the corneal button revealed crystalline calcium deposits throughout all layers of the corneal stroma but sparing Bowman's layer. The deposits were mainly intracellularly located within the cytoplasm of degenerative keratocytes. Energy-dispersive x-ray analysis confirmed the presence of calcium phosphate. The calcium deposits were closely associated with intra- and pericellular accumulations of acid mucopolysaccharides.

Conclusion: In the patient's sensitized condition, the addition of phosphate-containing medications may have predisposed to the intracellular precipitation of calcium phosphate by increasing the interstitial concentration of phosphate. We recommend a careful follow-up of predisposed patients using phosphated eye drops for this rare but potential complication of corneal stromal calcification.

Universitäts-Augenklinik Erlangen

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