The Nationwide Study of Epikeratophakia for Myopia

McDonald, Marguerite B.; Kaufman, Herbert E.; Aquavella, James V.; Durrie, Daniel S.; Hiles, David A.; Hunkeler, John D.; Keates, Richard H.; Morgan, Keith S.; Sanders, Donald R.

doi:10.1016/s0002-9394(14)77760-8

Cited by 95 publications

(14 citation statements)

References 18 publications

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“…In addition, in 4 of 12 eyes astigmatism increased more than 1 diopter. Thus, the present refractive outcome is certainly not perfect, but it is comparable to results obtained in larger studies of epikeratophakia for myopia, in which epi-lens powers were individualized (McDonald et al 1987b). In the present study all eyes were within one line or better of the best corrected preoperative visual acuity.…”

Section: Discussionsupporting

confidence: 83%

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Epikeratophakia for high myopia

Hjortdal

Ehlers

1991

Acta Ophthalmologica

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A cryo-technique for production of corneal epi-lenses has been developed. During the manufacturing procedure the anterior surface of the tissue is moulded and the posterior surface cut with a microtome. After cutting, the epi-lenses are stored for days to weeks in an organ culture medium. Twelve eyes in 10 patients have been treated with epikeratophakia for high myopia (greater than -7 D). In all eyes, epithelialization was complete within one week, and at follow-up 3-18 months after the operation all epi-lenses were clear. The average refractive change in spherical equivalents was 9.7 +/- 4.4 D. All eyes obtained better uncorrected visual acuity, and no eyes lost more than one line of the best corrected visual acuity. At the time of follow-up, the patients' native cornea had regained normal hydration, whereas the epi-lenses did not thin as much as expected.

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Section: Discussionsupporting

confidence: 83%

“…Epikeratophakia, whereby the anterior curvature of the cornea is changed by a human tissue contact lens, has been found a safe and usehl procedure for correction of aphakia in children Morgan et al 1987) and adults (McDonald et al 1987a), correction of high myopia (McDonald et al 1987b), and for treatment of keratoconus McDonald et al 1986).…”

mentioning

confidence: 99%

Epikeratophakia for high myopia

Hjortdal

Ehlers

1991

Acta Ophthalmologica

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“…In the same period of time almost 40 patients were treated with epikeratoplasty, suggesting a failure rate of 10-15%. Overall epi-lenticule removal rates have in larger studies been reported to 10% for myopic epikeratophakia (McDonald et al 1987b) and to 4% in epikeratophakia for adult 366 aphakia (McDonald et al 1987a). Including the present cases, histopathological examination of 30-40 removed human epi-lenticules have been reported.…”

Section: Discussionmentioning

confidence: 54%

Histopathological findings in failed human epikeratophakia lenticules

Wang

Hjortdal²,

Ehlers³

et al. 1994

Acta Ophthalmologica

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Six human epikeratophakia lenticules were removed 1 to 23 months after refractive keratoplasty for aphakia (n = 2) and myopia (n = 4). The myopic group included one epi-lenticule treated with ArF-excimer laser for hyperopia. Reasons for removal were epithelial defect (n = 4), edema of host cornea (n = 1), and overcorrection (n = 1). The epi-lenticule stroma showed centrally a regular fibrillar structure with a low keratocyte density. Electron microscopy (n = 1) revealed preserved cytoplasmic organelles and nuclear appearance. Mononuclear cells were absent. Polysaccharide was demonstrated in the stroma. Bowman's layer was normal without breaks. The epithelium had variable thickness. In the peripheral wound region stromal and epithelial irregularities were evident.

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“…1 Although epikeratophakia was first introduced for the rehabilitation of vision in aphakia as an alternative to secondary implantation of intraocular lenses (IOLs), 2 its most common indication was advanced keratoconus when other treatment options, such as corrective visual aids and penetrating keratoplasty (PKP), were not tolerated or appropriate. 1,3 To a lesser extent, epikeratophakia has been indicated in myopia and hyperopia for similar reasons. 3,4 Because it is a form of onlay lamellar keratoplasty, it has many of the advantages of lamellar keratoplasty, an extraocular procedure, such as preservation of host endothelium and elimination of the risk for endothelial rejection and traumatic dehiscence of the globe; it is also potentially reversible and possibly less technically challenging.…”

Section: J Cataract Refract Surg 2008; 34:1793-1798 Q 2008 Ascrs and mentioning

confidence: 99%

“…1,3 To a lesser extent, epikeratophakia has been indicated in myopia and hyperopia for similar reasons. 3,4 Because it is a form of onlay lamellar keratoplasty, it has many of the advantages of lamellar keratoplasty, an extraocular procedure, such as preservation of host endothelium and elimination of the risk for endothelial rejection and traumatic dehiscence of the globe; it is also potentially reversible and possibly less technically challenging. 5 We present an interesting case of epikeratophakia 17 years after initial transplantation, with a focus on the corneal microstructure imaged by in vivo confocal microscopy.…”

Section: J Cataract Refract Surg 2008; 34:1793-1798 Q 2008 Ascrs and mentioning

confidence: 99%

Long-term microstructural changes following epikeratophakia: In vivo confocal microscopy study

Fan

Patel

McGhee

2008

Journal of Cataract and Refractive Surgery

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The unilateral epikeratophakic eye of a 20-year-old woman with a history of congenital cataracts was examined using laser scanning in vivo confocal microscopy 17 years after transplantation. In vivo confocal microscopy demonstrated a reduced keratocyte density in the grafted lenticule and the host stroma, with unusual elongated and tortuous hyperreflective branching structures in the anterior stroma of the host cornea. The sub-basal nerve plexus was present in the lenticule, although with a reduced nerve density. The appearance of the host endothelium was similar to that observed in Fuchs endothelial dystrophy. Dramatic microstructural changes were observed in almost all layers of the cornea 17 years after epikeratophakia. Although no longer performed as routine practice, in vivo confocal microscopy examination of epikeratophakia has provided fascinating insight into the potential corneal adaptations at a cellular level.

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The Nationwide Study of Epikeratophakia for Myopia

Cited by 95 publications

References 18 publications

Epikeratophakia for high myopia

Epikeratophakia for high myopia

Histopathological findings in failed human epikeratophakia lenticules

Long-term microstructural changes following epikeratophakia: In vivo confocal microscopy study

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