title: [A preliminary report of epikeratophakia combined with two-stage photorefractive keratectomy in the treatment of keratoconus].
abstract: OBJECTIVE
  To study the clinical results of epikeratophakia (EP) combined two-stage photorefractive keratectomy (PRK) in the treatment of keratoconus.
  
  
  METHODS
  (1) Admission criteria for EP included: Best corrected visual acuity (BCVA) was no more than 0.3, keratoconus patients without scar in the central cornea could not tolerance the rigid gas permeable contact lens and corneal curvature was no more than 60.0 D. Criteria for the PRK included cornea astigmatism stable within 0.5 D for at least 3 months after EP, patient's age was 18 years or older, and absence of ocular disease, such as glaucoma or dry eye. (2) SURGICAL TREATMENT: EP surgery was performed and then followed by PRK at the second stage. (3) Postoperative follow up: Postoperative follow up included the examination of vision, corneal curvature, complications and immune rejection.
  
  
  RESULTS
  Eight patients (10 eyes) received PRK after EP. BCVA was 0.3 - 0.5 in 1 eye and >or= 0.5 in 9 eyes in 12 - 18 months after EP. BCVA was >or= 0.5 in all eyes 12 months after PRK and 5 eyes obtained a BCVA of 1.0. The mean corneal astigmatism was (7.3 +/- 1.8) D before EP surgery, (3.8 +/- 1.6) D 12 - 18 months after EP, and (1.6 +/- 0.9) D after PRK. All grafts remained clear and no immune rejection was found after EP. 0.5 degree haze was observed in 1 eye, and no recurrence of keratoconus was found after PRK during the follow up period.
  
  
  RESULTS
  secondary glaucoma (with disappearance of the anterior chamber) occurred in one eye 6 hours after EP surgery, and symptoms disappeared after reconstruction of the anterior chamber. The sutures were loosened in one cornea during the first 3 months after EP, it was corrected by resuture.
  
  
  CONCLUSIONS
  EP combined with two-stage PRK is an effective method in treatment of keratoconus.
authors.affiliation: Qingdao Eye Hospital, Shandong Eye Institute, Qingdao 266071, China. lixinxie@public.qd.sd.cn
authors.forename: Li-xin
authors.initials: LX
authors.lastname: Xie
authors.forename: Hua
authors.initials: H
authors.lastname: Gao
mesh_terms: D000293:Adolescent; D017391:Epikeratophakia / Q000379:methods*; D005260:Female; D006801:Humans; D007640:Keratoconus / Q000601:surgery*; D008297:Male; D018903:Photorefractive Keratectomy / Q000379:methods*; D012030:Refractive Errors / Q000628:therapy*; D055815:Young Adult