Epikeratoplasty for adult and pediatric aphakia, myopia, and keratoconus: the Massachusetts Eye and Ear Infirmary experience

Non-Freeze Epikeratophakia in Children

We describe the use of unfrozen tissue lenses in 42 cases of epikeratophakia in children aged 2-14 years. Fourteen operations were performed in an aphakic eye, 28 in combination with congenital or traumatic cataract extraction. The tissue lenses, made from unfrozen donor cornea according to an original design, healed in 91.5% of cases. The tissue lens was removed when epithelial growth was inadequate on its surface. A five-year follow-up showed that correction within 3.0 D of emmetropia was achieved in 73.7% of the eyes. Preoperatively, mean keratometry readings were 43.5±0.2 D, increasing postoperatively to 53.6±0.8 D. Mean spherical equivalent at the spectacle plane increased by 9.6±0.9 D. Our investigations show the efficacy and safety of non-freeze epikeratophakia in the correction of pediatric aphakia.

Epikeratoplasty for Keratoconus Using Manually Dissected Fresh Lenticules: 4-year Follow-up

BACKGROUND

Epikeratoplasty for keratoconus, in the absence of apical scarring, aims at reducing high irregular myopic astigmatism and provides an ectatic cornea with mechanical support.

METHODS

We performed epikeratoplasty on 11 keratoconic corneas using fresh or McCarey-Kaufman preserved, manually dissected donor lenticules. A disparity of 0.5 mm was maintained between the host and the donor. Patients with keratoconus having a preoperative spectacle-corrected visual acuity of less than 6/60 and intolerance to contact lens wear were included in this prospective study. Spectacle-corrected visual acuity, keratometry, and refraction were analyzed over a 4-year follow-up period.

RESULTS

Four year follow-up was completed on 10 eyes. Of these, 80% achieved a postoperative spectacle-corrected visual acuity of 6/12 or better. Average postoperative keratometry was 45.79 +/- 2.07 D and a decrease of 4.60 +/- 0.09 D was observed in refractive cylinder. Spherical equivalent showed a significant decrease in myopia of -4.35 +/- 0.26 D. Mean time to stabilization was 8 +/- 2.3 weeks. Epithelial defects occurred in three eyes; two were successfully treated by patching. One lenticule was removed due to graft infection following a persistent epithelial defect.

CONCLUSION

Epikeratoplasty for keratoconus is a useful procedure with good long-term visual acuity results and an early stabilizing period.