Long-term follow-up of pediatric epikeratophakia

Epikeratophakia is a potentially reversible corneal surgical procedure that can correct refractive errors in children who are aphakic and poor candidates for intraocular lens implantation. The correction of aphakia in the pediatric population poses specific problems because of associated amblyopia.

The clinical records of 61 consecutive patients (82 eyes) treated for pediatric aphakia by epikeratophakia were reviewed retrospectively with a follow-up of 3 to 5 years. For the purpose of analysis, the patients were divided into seven groups.

The overall success rate for epikeratophakia was 92%, but with repeated surgery, the patient success rate was 93%. The average refractive error at 1 year was + 0.10 diopters (D). At 1 year, 68% of eyes had a refraction within 1 D of emmetropia. In these growing eyes, we documented an average myopic shift of -0.40 D during 4 years. A myopic shift occurred in 30.2% and a hyperopic shift in 9.4% of eyes. Spectacle-corrected visual acuity at 3 years showed 36% of eyes seeing 20/40 or better. Visual acuity results in different groups varied with the timing of epikeratophakia, density of amblyopia and parents' ability to maintain the patching schedule. The most encouraging results came from the treatment of monocular traumatic cataracts. In this group, 31% achieved visual acuities of 20/40 or better and 85% achieved 20/100 or better at final examination. Those with incomplete congenital cataracts also showed favorable results: 39% achieved 20/40 or better at final examination.

Follow-up of 3 to 5 years demonstrated that epikeratophakia can correct refractive errors safely and successfully in aphakic children, either as a primary procedure, or as a secondary procedure after cataract extraction.