Epikeratoplasty for keratoconus using manually dissected fresh lenticules: 4-year follow-up.

Abstract

Epikeratoplasty for keratoconus, in the absence of apical scarring, aims at reducing high irregular myopic astigmatism and provides an ectatic cornea with mechanical support. 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. 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. Epikeratoplasty for keratoconus is a useful procedure with good long-term visual acuity results and an early stabilizing period.