Outcomes of epikeratoplasty for advanced keratoglobus

To determine the visual and anatomic outcomes of epikeratoplasty in keratoglobus.

In an interventional case series, 7 eyes of 6 patients with keratoglobus (KGB), 5 to 39 years of age, underwent epikeratoplasty. Three patients (3 eyes) had blue sclera, joint hypermobility, and consanguineous parents; 3 other patients (4 eyes) had only KGB. In the blue sclera group, all patients had lost the fellow eye because of minor trauma. We used a corneo-scleral button 1 mm larger than corneal diameter as an onlay graft. Orbscan pachymetry was performed before and 3 months after surgery.

Mean visual acuity was 20/400 preoperatively and improved to 20/160 postoperatively. Mean central corneal thickness was 200 microm preoperatively, which increased to 800 microm after surgery. Epithelial inclusion cysts developed in 1 patient. Severe interface vascularization was observed in 1 eye of the blue sclera group, which had total Descemet membrane detachment before epikeratoplasty. Neurotrophic ulcer occurred in 1 case, which improved with tarsorrhaphy, punctal occlusion, and medical therapy.

Epikeratoplasty is a safe and effective procedure in preserving ocular integrity and increasing visual acuity in patients with keratoglobus and should be considered before corneal perforation, which often results in loss of an eye.