Long-term functional and topographic results seven years after epikeratophakia for keratoconus.
OBJECTIVE
To analyze the long-term effect of epikeratophakia (EKP) on corneal topography and visual acuity of eyes with keratoconus.


METHODS
Retrospective study of 36 eyes 7.2 years after EKP. Four eyes underwent penetrating keratoplasty (PKP) and were excluded from further evaluation. Best-corrected visual acuity (BCVA) values were obtained from 32 eyes, corneal refraction and astigmatism from 23 eyes, surface asymmetry index (SAI) and surface regularity index (SRI) from 17 consecutive eyes that were operated upon after 1991, when the Tomey Topographic Modeling System became available.


RESULTS
Only four eyes needed PKP. In addition to EKP six eyes had compression sutures and/or relaxing incisions, and one eye underwent photorefractive keratectomy. Mean refractive power of the cornea decreased from 51.8 to 45.8 and astigmatism from 7.2 to 3.8. SAI improved from 3.2 to 0.9 and SRI from 3.7 to 0.9. Mean BCVA was 0.3 preoperatively and 0.6 upon last follow-up.


CONCLUSIONS
EKP was able to render PKP unnecessary in 32 of 36 eyes during the entire observation period. It was successful in permanently flattening the ectatic cornea and reducing astigmatism while restoring a symmetrical and smooth corneal surface. As a result, visual acuity improved considerably. In view of the young age of keratoconus patients needing surgery, and the fact that the lifetime of full-thickness corneal grafts is limited, EKP should be considered a valuable alternative to PKP in contact-lens-intolerant cases of keratoconus without central scarring.
Department of Ophthalmology, University of Bonn Medical Center, Sigmund-Freud-Strasse 25, 53105 Bonn, Germany. umc000@uni-bonn.de
Manfred
M
Spitznas
Jens
J
Eckert
Martine
M
Frising
Nicole
N
Eter
D000328:Adult; D001251:Astigmatism / Q000517:prevention & control; D003315:Cornea / Q000502:physiology* / Q000601:surgery; D019781:Corneal Topography; D017391:Epikeratophakia / Q000502:physiology*; D005500:Follow-Up Studies; D006801:Humans; D007640:Keratoconus / Q000503:physiopathology* / Q000601:surgery*; D015948:Keratoplasty, Penetrating; D012029:Refraction, Ocular / Q000502:physiology; D012189:Retrospective Studies; D013536:Suture Techniques; D014792:Visual Acuity / Q000502:physiology