title: Live-epikeratophakia for keratoconus.
abstract: OBJECTIVE
  To assess the clinical feasibility of refractive live-epikeratophakia (L-EPI) for early keratoconus to cap, rather than reverse, the ectatic cornea.
  
  
  METHODS
  Eye Department, Martin-Luther-Hospital, Bochum, Germany.
  
  
  METHODS
  Twenty-seven consecutive cases with keratoconus stage I-II had L-EPI. Lenticules were obtained from eye-bank eyes. The lenticules were cut on the artificial anterior chamber bench of the Barraquer-Krumeich-Swinger set. Optical power was generated over refractive dies to achieve postoperative emmetropia. The lenticule was sutured into a peripherally undermined 7.0 mm trephination with a double-running torque suture.
  
  
  RESULTS
  Re-epithelialization was complete within 4 to 6 days. In all but three cases that had corneal ulcers and experienced partial melting of tissue following severe neurodermatitis, all lenticules remained stable during the 10 year follow-up. The 1 month spherical equivalent remained almost stable over the entire follow-up. There was no sign of progression of keratoconus as induced myopia or astigmatism indicated by keratometry readings. Mean best spectacle-corrected visual acuity (BSCVA) was 0.45 (n = 27) preoperatively and 0.19 (n = 25) at 1 week, 0.39 (n = 26) at 1 month, 0.53 (n = 20) at 6 months, 0.58 (n = 13) at 1 year, and 0.64 (n = 8) at 2 years. Preoperative BCVA was achieved or improved in 13 eyes at 1 month. Postoperative astigmatism was < or = 3.25 diopters. Neither rejection nor lenticule opacification was observed.
  
  
  CONCLUSIONS
  Live-epikeratophakia is a safe and minimally invasive extraocular procedure suitable for keratoconus stage I-II. Progression of keratoconus may be arrested. If unsuccessful, the procedure is complementable and there is no interference with a later penetrating keratoplasty.
authors.affiliation: Eye Department, Martin-Luther-Hospital Bochum, Germany.
authors.forename: J H
authors.initials: JH
authors.lastname: Krumeich
authors.forename: J
authors.initials: J
authors.lastname: Daniel
authors.forename: A
authors.initials: A
authors.lastname: Knülle
mesh_terms: D003315:Cornea / Q000601:surgery*; D017391:Epikeratophakia; D005240:Feasibility Studies; D005500:Follow-Up Studies; D006801:Humans; D007640:Keratoconus / Q000601:surgery*; D012189:Retrospective Studies; D012449:Safety; D016896:Treatment Outcome; D014792:Visual Acuity