98th Annual Meeting DOG 2000

P 104

Massive corneal stromal calcification following graft-versus-host-disease

T. Yousif, V. Müller, M. Tetz

Introduction: Calcific band keratopathy with calcium deposition in Bowman’s membrane is a common disease. However, calcium deposition throughout all layers of the cornea is rare. We report on a patient with massive stromal calcification.

Case report: A 44-year-old woman with acute lymphoblastic leukemia underwent allegoric bone marrow transplantation. Six month later she developed graft-versus-host disease with severe keratoconjunctivitis sicca. 1 1/2 years later she was referred to our clinic with bilateral conjunctival hyperemia, epithelial lesions and extensive stromal calcifications, some smaller calcifications reaching predescemet stroma layers. The patient underwent surgical removal of the deposits using EDTA. Infrared spectroscopic examination of the deposits revealed 100 % calcium phosphate. Intense local treatment with steroids and hyaluronic acid finally lead to epithelial healing. Serum levels of calcium and phosphate have always been in normal range.

Discussion: Ocular complications following graft-versus-host disease have previously been described: Pseudomembranous conjunctivitis, keratoconjunctivitis sicca, and cataract. Corneal abnormalities including keratitis, corneal perforation, corneal neovascularisation and corneal scarring. A single case report described calcium deposition throughout all layers of a cornea. The causative mechanism of calcium phosphate precipitation has not been elucidated. Mild elevation of local calcium and phosphate levels, the decrease in tear production and changing pH-values may be involved.

Department of Ophtalmology, Charité, Campus Virchow-Klinikum, D-13353 Berlin