The correction of aphakia. XXXVI Edward Jackson Memorial Lecture

Major advances in the correction of aphakia have been made in the past few years. Extended-wear contact lenses constitute one advance, if not a perfect one. Intraocular lenses are now safer to use, and new research is seeking ways to improve their safety through protection of the corneal endothelium during surgery and stimulation of endothelial healing where damage does occur. Altering the refractive power of the cornea offers another possible approach to the correction of aphakia. Modifications of Barraquer's keratomileusis procedure using preserved, preground corneas may have definite indications for certain types of aphakia, such as monocular aphakia in children and in individuals who would otherwise require secondary implants. We have experimented with a "living contact lens" of shaped donor tissue attached to the de-epithelialized surface of the eye. Such a lens of preground, preserved cornea tissue can be sutured to the patient's cornea with its central Bowman's membrane intact. A peripheral trephine mark is made, but the central cornea is untouched and the attachment of the living lens is simple. The procedure is apparently safe, and should be usable by any competent ophthalmic surgeon if the long-term results continue to be as encouraging as our early experience now suggests.