Search

A nationwide study of epikeratophakia for aphakia in older children was conducted from March 1984 to March 1986. Sixty-three patients, 8 to 18 years of age, underwent this procedure in 65 eyes. Twenty-eight patients had congenital cataracts and 35 had traumatic cataracts. Fifty-one of the 65 eyes were aphakic at the time of surgery (secondary procedures). All surgeries were successful; no tissue lenses were lost or removed. Postoperatively, 73% of the patients were within 3 diopters (D) of emmetropia. The patients with congenital cataracts gained an average of one Snellen line of best-corrected visual acuity; patients with traumatic cataracts lost an average of one Snellen line of best-corrected visual acuity. In older pediatric patients, epikeratophakia appears to be a safe and effective procedure for the correction of aphakia.

The nationwide study of epikeratophakia for the treatment of keratoconus involved 69 surgeons in the United States; they operated on 177 eyes as of Dec 31, 1985. In this first report, the results from 35 surgeons involving 82 cases with 30 or more days of follow-up after suture removal are described. In all but two patients, uncorrected visual acuity improved; 17 patients showed improvement of three Snellen lines, and 38 patients showed improvement of four or more lines. The majority of patients' vision returned to within one line of their best corrected acuity; in 78% it was 20/40 or better postoperatively. Eight patients needed no postoperative overrefraction at all. The mean flattening by keratometry readings was 9.36 diopters, and the mean decrease in myopia in terms of spherical equivalent was 5.26 D. No significant changes in intraocular pressure or endothelial cell counts were noted. Some advantages of epikeratophakia for keratoconus over the traditional penetrating keratoplasty include the lack of serious, vision-threatening complications or permanent vision loss, the reversible nature of the surgery, and the absence of potential immunogenic rejection phenomena.