Epikeratophakia for Correction of Refractive Error after Unilateral Congenital Cataract Extraction

Abstract

Fifteen children with unilateral congenital cataracts received epikeratophakia grafts for the correction of aphakia. Twelve of them had dense and three had incomplete cataracts. The majority of patients with dense cataracts (10/12) underwent cataract extraction as a primary treatment. Epikeratophakia was performed in these children as a secondary procedure when contact lens therapy failed. Two of the children with dense cataracts and all those with incomplete cataracts underwent combined cataract extraction and epikeratophakia. Follow-up ranged from 10 months to 3.5 years. Of the 15 epikeratophakia procedures performed 93.3% (14/15) were successful. Postoperative visual acuity (VA) of 20/200 or better was achieved in three (27.3%) of the 11 patients with dense cataracts who had successful surgery. The majority (9/11) of these children demonstrated improvement in VA after a combination of epikeratophakia and amblyopia therapy. All the children with incomplete unilateral cataracts had good VA at the end of follow-up. The refractive results in children who were treated as a secondary procedure were better than those treated in combination with lensectomy; the amount of correction was remarkably predictable in both. The results have demonstrated that epikeratophakia corrects refractive errors in aphakic children safely and successfully, either as a primary procedure, or as a secondary procedure after cataract extraction.