title: Modified surgical technique for repeated epikeratophakia surgery in aphakic eyes.
abstract: BACKGROUND
  Incomplete epithelial removal from the peripheral keratectomy at the time of repeat epikeratophakia surgery can lead to interface downgrowth and consequent failure, as observed in the case reported herein. We present a modification of the standard surgical technique aimed at avoiding such complication.
  
  
  METHODS
  A 69-year-old white female underwent a third aphakic epikeratophakia modified to reduce the risk of epithelial interface downgrowth, which had caused a previous failure. The aphakic tissue lens, 8.5 mm in diameter, was sutured into a corneal pocket obtained at a deeper level, inside the peripheral keratectomy used for the previous two procedures.
  
  
  RESULTS
  Useful visual acuity (20/60) was obtained and the refractive outcome remained stable up to 1 year postoperatively. Epithelial interface downgrowth did not recur.
  
  
  CONCLUSIONS
  Despite the possible risk of perforation while undermining the recipient cornea at a deeper level, the modified technique might offer a more effective method of preventing epithelial downgrowth after repeat epikeratophakia surgery.
authors.affiliation: University Eye Hospital, University of Bonn, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Busin
authors.forename: A
authors.initials: A
authors.lastname: Cusumano
mesh_terms: D000368:Aged; D001035:Aphakia / Q000601:surgery*; D017391:Epikeratophakia / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D012086:Reoperation; D014792:Visual Acuity