Retrospective comparison of freeze and non-freeze myopic epikeratophakia

We conducted a retrospective study of 20 eyes of 20 selected patients with preoperative myopia of -14 to -28 diopters who were treated with myopic epikeratophakia and followed for 8 weeks. Seven eyes were treated with frozen-lyophilized donor lenticules by the Kaufman-McDonald technique and 13 eyes were treated with freshly prepared donor lenticules using the Barraquer-Krumeich-Swinger (BKS) technique. All lenticules were sutured into a circular keratotomy without keratectomy. Postoperatively, all eyes had a refraction between -4.00 and +2.00 D, and there was no meaningful difference in the refractive outcome of the two groups. The freeze-lyophilized technique showed a greater overall loss of best spectacle corrected visual acuity, although no eyes in the entire series lost more than two lines of Snellen visual acuity compared to preoperative values. Uncorrected visual acuity after surgery was 20/40 or better in 5% of each group. The rate of postoperative epithelialization was slower in the freeze-lyophilized group, but all eyes were re-epithalialized by 3 weeks after surgery. No lenticules had to be removed for complications, but there was one case of epithelial ingrowth into the interface that required a second operative procedure. Our clinical experience with this small group of eyes shows that both techniques of myopic epikeratophakia can safely and effectively reduce high amounts of myopia, but that the refractive outcome is less predictable than desired. The technical requirements for the non-freeze (BKS) technique are high, but the rate of visual recovery is faster.