title: Deep corneal calcification associated with preservative-free eyedrops and persistent epithelial defects.
abstract: OBJECTIVE
  To describe the formation of deep calcareous degeneration of the cornea associated with the use of preservative-free eyedrops in patients with a persistent epithelial defect and active ocular surface inflammation.
  
  
  METHODS
  A case series of 6 patients with persistent epithelial defects (1 with diabetes, 3 with penetrating keratoplasty, and 2 with herpes zoster) treated with preservative-free medications was reviewed over 18 months. Each patient subsequently developed deep calcareous corneal degeneration. Data regarding underlying etiology, diagnosis, clinical findings, and medications used were recorded. Each medication used was analyzed for phosphate levels by using a Roche 917 analyzer.
  
  
  RESULTS
  All 6 cases of calcareous degeneration of the cornea had persistent epithelial defects, treated with preservative-free medications (timolol, dexamethasone, and prednisolone), in the presence of active inflammation on the ocular surface. The mean levels of phosphate were 130, 42.9, and 22.9 mM in timolol, dexamethasone, and prednisolone, respectively. All 6 patients had some degree of corneal opacification and reduced visual acuity.
  
  
  CONCLUSIONS
  A contributory factor in our case series seems to be the use of preservative-free medications in persistent epithelial defects. The preservative-free medications we measured had high levels of phosphate, which may not be common knowledge.
authors: Croydon Eye Unit, Mayday University Hospital, London, UK. lakedomian@hotmalil.com
authors: Damian
authors: D
authors: Lake
authors: Anne
authors: A
authors: Tarn
authors: William
authors: W
authors: Ayliffe
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002114:Calcinosis / Q000139:chemically induced* / Q000175:diagnosis; D003316:Corneal Diseases / Q000139:chemically induced* / Q000175:diagnosis; D003907:Dexamethasone / Q000009:adverse effects*; D019573:Epithelium, Corneal / Q000187:drug effects* / Q000473:pathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009883:Ophthalmic Solutions / Q000009:adverse effects; D011239:Prednisolone / Q000009:adverse effects / Q000031:analogs & derivatives*; D011310:Preservatives, Pharmaceutical / Q000009:adverse effects*; D013999:Timolol / Q000009:adverse effects*; D014792:Visual Acuity / Q000187:drug effects
chemical_list: D009883:Ophthalmic Solutions; D011310:Preservatives, Pharmaceutical; C009022:prednisolone phosphate; D003907:Dexamethasone; D013999:Timolol; D011239:Prednisolone