Epikeratophakia for the correction of myopia: lenticule design and related histopathological findings

In spite of the numerous changes in surgical technique, epikeratophakia for the correction of myopia is still far from achieving optimal results. The removal rate of myopic lenticules is much higher than that of aphakic or keratoconus lenticules and has prompted the FDA to deny its approval to the industrial production of epi-lenses for the correction of myopia. We report a patient who underwent epikeratophakia for the correction of high myopia in his left eye and required removal of the lenticule because of unsatisfactory visual outcome. The histologic and electron microscopic examination of the removed lenticule revealed the presence of folds in both Bowman's layer and superficial stroma. These had been described in the past and related to the surgical technique used at that time; they were thought to be the cause of poor visual acuity n two patients, and had prompted, therefore, a change in surgical technique. Our findings suggest that the present lenticule design could be responsible for the presence of folds and the consequent poor visual result.