Long-term results of epikeratoplasty for keratoconus

By analysis of outpatient records at the Massachusetts Eye and Ear Infirmary, the clinical course of 10 consecutive patients who underwent epikeratoplasty for keratoconus was reviewed to determine their clinical and functional status 5 years after surgery. Eight of 10 patients (80%) had clear, intact lenticules at 12 months. During a mean follow-up of 67 months (range = 35-101 months), each maintained long-term stability of best corrected vision, refractive astigmatism, and keratometric astigmatism. The mean uncorrected visual acuity improved from 20/660 to 20/134, whereas the mean spectacle corrected acuity improved from 20/260 to 20/30. All but one patient had a spectacle acuity equal to hard contact lens acuity. However, no patients were corrected to 20/20 at the end of the follow-up period. Refractive and keratometric astigmatism stabilized by 12 months (mean = 3.62 and 3.05 D, respectively), and decreased slightly during the longer period of follow-up (mean = 2.94 and 2.17 D, respectively). Epikeratoplasty is a useful method of visual rehabilitation in highly selected cases of keratoconus in which there is no central opacity, preoperative hard contact lens acuity is worse than 20/40, the average keratometry is < 60 D, contact lens intolerance is present, and in which the patient will tolerate some degree of reduced contrast sensitivity and < 20/20 high contrast acuity.