Live-epikeratophakia for keratoconus

To assess the clinical feasibility of refractive live-epikeratophakia (L-EPI) for early keratoconus to cap, rather than reverse, the ectatic cornea.

Eye Department, Martin-Luther-Hospital, Bochum, Germany.

Twenty-seven consecutive cases with keratoconus stage I-II had L-EPI. Lenticules were obtained from eye-bank eyes. The lenticules were cut on the artificial anterior chamber bench of the Barraquer-Krumeich-Swinger set. Optical power was generated over refractive dies to achieve postoperative emmetropia. The lenticule was sutured into a peripherally undermined 7.0 mm trephination with a double-running torque suture.

Re-epithelialization was complete within 4 to 6 days. In all but three cases that had corneal ulcers and experienced partial melting of tissue following severe neurodermatitis, all lenticules remained stable during the 10 year follow-up. The 1 month spherical equivalent remained almost stable over the entire follow-up. There was no sign of progression of keratoconus as induced myopia or astigmatism indicated by keratometry readings. Mean best spectacle-corrected visual acuity (BSCVA) was 0.45 (n = 27) preoperatively and 0.19 (n = 25) at 1 week, 0.39 (n = 26) at 1 month, 0.53 (n = 20) at 6 months, 0.58 (n = 13) at 1 year, and 0.64 (n = 8) at 2 years. Preoperative BCVA was achieved or improved in 13 eyes at 1 month. Postoperative astigmatism was < or = 3.25 diopters. Neither rejection nor lenticule opacification was observed.

Live-epikeratophakia is a safe and minimally invasive extraocular procedure suitable for keratoconus stage I-II. Progression of keratoconus may be arrested. If unsuccessful, the procedure is complementable and there is no interference with a later penetrating keratoplasty.