Epikeratophakia for control of pediatric bullous keratopathy

A child who had had a congenital cataract phacoemulsified at age four months became contact lens intolerant, and at age two years had an implantation of a Worst metal-looped iris-clip intraocular lens. He developed painful pseudophakic bullous keratopathy three years later. Since the child remained with dense deprivation amblyopia and contact lens intolerance, when the IOL was removed an epikeratophakia graft was applied. The bullous keratopathy resolved and the patient has remained asymptomatic for 22 postoperative months. The proposed mechanism for relief of the bullous keratopathy is to increase tissue thickness and resistance, thus reducing fluid volume transferred to the subepithelial space.