title: Anatomical and functional graft survival, 10 years after epikeratoplasty in keratoconus.
abstract: OBJECTIVE
  To report outcomes of epikeratoplasty in keratoconus (KC), utilizing manually-prepared plano donor lenticules in terms of flattening of the cone, reduction in astigmatism and improvement in the visual acuity.
  
  
  METHODS
  Patients with KC, having visual acuity <20/200, astigmatism >12 diopters (D) but without corneal opacity underwent epikeratoplasty, using manually prepared plano donor lenticules from fresh or M.K preserved corneas, between 1990 - 2000 and followed for 10 years, were included in this report. Visual acuity slit-lamp-biomicroscopy, keratometry, and refraction were performed at 8 weeks, 12 weeks, and 6 months for all 59 patients. The same were carried out at 1 year, 5 years, and 10 years depending upon the availability of the patient for that period.
  
  
  RESULTS
  Of the 59 patients, only 26 were available for follow-up after 10 years. At 3 months, 1 year and 5 years, best corrected visual acuity of (BCVA) ≥20/60 were achieved in 84.7%, 84.4% and 80.3% of eyes, respectively. BCVA was 73% at 10-year follow- up, which was due to the presence of posterior subcapsular cataract (PSC). The average keratometric astigmatism and average flattening in diopters stabilized at the end of 3 months, which remained constant at 1, 5, and 10-year follow-up. The average diopter of myopia was stabilized by 1 year, which was almost same at 10 year. Graft was clear in all but 1 eye at 10 year follow-up.
  
  
  CONCLUSIONS
  Epikeratoplasty is a useful technique for keratoconic eyes without apical scarring who fail or unable to use contact lenses.
authors.affiliation: Cornea and OSD Services, Dr. R P Centre, AIIMS, New Delhi, India.
authors.forename: Anita
authors.initials: A
authors.lastname: Panda
authors.forename: Anoop K
authors.initials: AK
authors.lastname: Gupta
authors.forename: Namrata
authors.initials: N
authors.lastname: Sharma
authors.forename: Sasikala
authors.initials: S
authors.lastname: Nindrakrishna
authors.forename: Rasik
authors.initials: R
authors.lastname: Vajpayee
mesh_terms: D000328:Adult; D003315:Cornea / Q000473:pathology*; D017391:Epikeratophakia / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D005544:Forecasting; D006085:Graft Survival / Q000502:physiology*; D006801:Humans; D007640:Keratoconus / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D012189:Retrospective Studies; D016896:Treatment Outcome; D014792:Visual Acuity; D055815:Young Adult