LONG-TERM RESULTS OF EPIKERATOPLASTY FOR KERATOCONUS

By analysis of outpatient records at the Massachusetts Eye and Ear Inf irmary, the clinical course of 10 consecutive patients who underwent e pikeratoplasty for keratoconus was reviewed to determine their clinica l and functional status 5 years after surgery. Eight of 10 patients (8 0%) had clear, intact lenticules at 12 months. During a mean follow-up of 67 months (range = 35-101 months), each maintained long-term stabi lity of best corrected vision, refractive astigmatism, and keratometri c astigmatism. The mean uncorrected visual acuity improved from 20/660 to 20/134, whereas the mean spectacle corrected acuity improved from 20/260 to 20/30. All but one patient had a spectacle acuity equal to h ard contact lens acuity. However, no patients were corrected to 20/20 at the end of the follow-up period. Refractive and keratometric astigm atism stabilized by 12 months (mean = 3.62 and 3.05 D, respectively), and decreased slightly during the longer period of follow-up (mean = 2 .94 and 2.17 D, respectively). Epikeratoplasty is a useful method of v isual rehabilitation in highly selected cases of keratoconus in which there is no central opacity, preoperative hard contact lens acuity is worse than 20/40, the average keratometry is <60 D, contact lens intol erance is present, and in which the patient will tolerate some degree of reduced contrast sensitivity and <20/20 high contrast acuity.