One-year follow-up of epikeratophakia for keratoconus

We report 1-year follow-up findings on 42 of the first epikeratophakia procedures performed for keratoconus at the Helsinki University Central Hospital. Altogether 40 patients (42 eyes) received epikeratophakia grafts to flatten their cones. The age of the patients ranged between 19 and 44 years. The mean follow-up for these patients was 10.7 +/- 4.4 months, and in 12 patients follow-up extended to over 12 months. Overall, the success rate for the procedure was 93%, and with repeated surgery it was 97% for all patients; in all patients uncorrected visual acuity improved. Preoperatively 82% of the patients had uncorrected acuity worse than 20/400, while all patients followed for 1 year had uncorrected visual acuity better than 20/400. At 6 and 12 months postoperatively best corrected visual acuities were all returned to within one line of their preoperative best corrected acuity; in 83% acuities were 20/40 or better 12 months postoperatively. Four patients out of 12 followed for 1 year needed no postoperative overrefraction at all. The mean flattening by keratometry readings was 9.8 diopters (D) and the mean decrease in myopia in terms of spherical equivalent was 5.3 D. The degree of irregular astigmatism was measured in five cases using LSU topographical corneal shape analysis, and showed that the mean preoperative irregular astigmatism of 3.9 D was reduced to 1.3 D in the long-term analysis. One case report is presented to show in detail the topographical changes induced by epikeratophakia in keratoconus. The noninvasive nature of the epikeratophakia procedure makes it a safe and desirable option for the treatment of keratoconus.