LIVE-EPIKERATOPHAKIA FOR KERATOCONUS

Purpose: To assess the clinical feasibility of refractive live-epikera tophakia (L-EPI) for early keratoconus to cap, rather than reverse, th e ectatic cornea. Setting: Eye Department, Martin-Luther-Hospital, Boc hum, Germany. Methods: Twenty-Seven consecutive cases with keratoconus stage I-II had L-EPI. Lenticules were obtained from eye-bank eyes. Th e lenticules were cut on the artificial anterior chamber bench oo the Barraquer-Krumeich-Swinger set. Optical power was generated over refra ctive dies to achieve postoperative emmetropia. The lenticule was sutu red into a peripherally undermined 7.0 mm trephination with a double-r unning torque suture. Results: Re-epithelialization was complete withi n 4 to 6 days. In all but three cases that had corneal ulcers and expe rienced partial melting of tissue following severe neurodermatitis, ai l lenticules remained stable during the 10 year follow-up. The 1 month spherical equivalent remained almost stable over the entire follow-up . keratoconus as induced myopia of astigmatism indicated by keratometr y readings. Mean best spectacle-corrected visual acuity (BSCVA) was 0. 45 (n = 27) preoperatively and 0.19 (n = 25) at 1 week, 0.39 (n = 26) at 1 month, 0.53 (n = 20) at 6 months, 0.58 (n = 13) at 1 year, and 0. 64 (n = 8) at 2 years. Preoperative BCVA was achieved pr improved in 1 3 eyes at 1 month. Postoperative astigmatism was less than or equal to 3.25 diopters. Neither rejection nor lenticule opacification was obse rved. Conclusions: Live-epikeratophakia is a safe and minimally invasi ve extraocular procedure suitable for keratoconus stage I-II. Progress ion of keratoconus may be arrested. If unsuccessful, the procedure is complementable and there is no interference with a later penetrating k eratoplasty.