LONG-TERM FOLLOW-UP OF PEDIATRIC EPIKERATOPHAKIA

BACKGROUND: Epikeratophakia is a potentially reversible corneal surgic al procedure that can correct refractive errors in children who are ap hakic and poor candidates for intraocular lens implantation. The corre ction of aphakia in the pediatric population poses specific problems b ecause of associated amblyopia, METHODS: The clinical records of 61 co nsecutive patients (82 eyes) treated for pediatric aphakia by epikerat ophakia were reviewed retrospectively with a follow-up of 3 to 5 years . For the purpose of analysis, the patients were divided into seven gr oups. RESULTS: The overall success rate for epikeratophakia was 92%, b ut with repeated surgery, the patient success rate was 93%. The averag e refractive error at 1 year was +0.10 diopters (D), At 1 year, 68% of eyes had a refraction within 1 D of emmetropia, In these growing eyes , we documented an average myopic shift of -0.40 D during 4 years, A m yopic shift occurred in 30.2% and a hyperopic shift in 9.4% of eyes. S pectacle-corrected visual acuity at 3 years showed 36% of eyes seeing 20/40 or better, Visual acuity results in different groups varied with the timing of epikeratophakia, density of amblyopia and parents' abil ity to maintain the patching schedule, The most encouraging results ca me from the treatment of monocular traumatic cataracts. In this group, 31% achieved visual acuities of 20/40 or better and 85% achieved 20/1 00 or better at final examination, Those with incomplete congenital ca taracts also showed favorable results: 39% achieved 20/40 or better at final examination, CONCLUSIONS: Follow-up of 3 to 5 years demonstrate d that epikeratophakia can correct refractive errors safely and succes sfully in aphakic children, either as a primary procedure, or as a sec ondary procedure after cataract extraction.