Acute band keratopathy following intracameral Viscoat
A. S. Nevyas, I. M. Raber, R. C. Eagle Jr, I. B. Wallace and H. J. Nevyas
Band keratopathy developed rapidly in two patients following uneventful
phacoemulsification and intraocular lens implantation using BSS Plus
(balanced salt solution enriched with glutathione, bicarbonate, and
glucose) infusion and Viscoat (chondroitin sulfate-sodium hyaluronate),
which was left in the anterior chamber at the conclusion of the procedure.
Histopathologic evaluation of corneal tissue obtained from one patient at
the time of edetic acid chelation revealed histochemical findings
consistent with anterior stromal calcification. To investigate a possible
relationship between Viscoat and the rapid onset of band keratopathy,
Viscoat formulated with varying concentrations of phosphate buffer was
injected intracamerally into 42 rabbit eyes. Within 48 hours, clinically
obvious corneal opacification developed in nine (47%) of 19 eyes injected
with the commercial preparation of Viscoat. Also, similar opacification
developed in ten (77%) of 13 eyes that received Viscoat formulated with
twice the phosphate concentration of the commercial preparation. Band
keratopathy did not develop any of ten eyes that received Viscoat with one
fourth the commercial phosphate concentration. In selected opacified
corneas, the presence of phosphorus in the subepithelial and posterior
corneal stroma was confirmed by histochemical stains and energy-dispersive
x-ray analysis.
