Band keratopathy developing after denosumab injections

We report the case of a 75-year-old woman who developed band keratopathy following denosumab therapy. The patient was referred for evaluation of progressive vision loss and new-onset band keratopathy in both eyes following denosumab therapy. She had no prior ocular history. On examination, she had calcific deposits in a horizontal band in the interpalpebral superficial cornea. Laboratory workup was negative. Denosumab was discontinued, and she was treated with keratectomy with ethylene-diamine-tetra-acetic acid. Denosumab influences calcium metabolism and consequently reduces bone turnover and increases bone density. It is commonly used for treatment of osteoporosis at high-risk for fracture. Very few cases of ocular adverse drug reactions have been reported. However, because of temporal association and biological plausibility, we believe our patient developed progressive band keratopathy after administration of denosumab.