PURPOSE: To report a case of cataract surgery in an epikeratophakia patient. CASE SUMMARY: A 59-year-old female with a history of epikeratophakic surgery 20 years ago complained of decreased visual acuity of both eyes for several months. She had nucleosclerotic and posterior subcapsular types of cataracts. Phacoemulsification and posterior capsule intraocular lens implantation were performed in both eyes. During surgery, corneal edema was especially prominent at the cornea with epikeratophakic lenticules in both eyes. In the left eye, severe corneal edema after one day of surgery was observed; however, after one week, corneal edema had subsided and visual acuity of both eyes had improved. CONCLUSIONS: When it necessary that cataract surgery is performed in patients with epikeratophakic lenticules, it is important to anticipate the corneal edema intraoperatively and postoperatively. Moreover, the surgeon should consider the acute calculation of the target refraction of intraocular lens in an epikeratophakia patient.
Cataract* ; Cornea ; Corneal Edema ; Epikeratophakia* ; Female ; Humans ; Lens Implantation, Intraocular ; Lenses, Intraocular ; Middle Aged ; Phacoemulsification ; Visual Acuity

In order to compare the clinical results of Epikeratoplasty (EPK) with Laser in situ keratomileusis(LASIK) to be corrected of high myopia above -9 diopters, the effect of the procedure on 74 patients following EKP and 63 patients following LASIK who were followed up at least 1 year were analyzed retrospectively. Postoperative mean uncorrected visual acuity was reached 0.56 until 3 month in EKP group and 0.53 until 1 month in LASIK group. LASIK group recovered and stabilized more rapidly than EKP guoup(p<0.01). Also LASIK group had more rapid recovery in keratometryp(p<0.01) and mean refractive error than EKP group(p<0.01). But there was no significant difference between two groups in uncorrected visual acuity(p=0.62), keratometry(p=0.41) and mean refractive error(p=0.32) at postoperative 1 year. LASIK seems to have more rapid and effective visual recovery than EKP for high myopia treatment.
Epikeratophakia* ; Humans ; Keratomileusis, Laser In Situ ; Myopia* ; Refractive Errors ; Retrospective Studies ; Visual Acuity

We performed 3 cases of epikeratoplasties on two pediatric aphakic patients who were intolerable to contact lenses & spectacles. These epikeratoplasties were performed in accordance with the Kaufman-McDonald Epikeratophakia Method using the commercially available frozen and dried Kerato-Lens (Allergan Medical Optics), the lenticule of which was rehydrated at the time of surgery. The cataract extractions were performed at 3 months after birth on both eyes of the congenital cataract & at 18 months after birth on the traumatic cataract that had developed at 14 months after birth. The epikeratoplasties for the eyes with congenital cataract were performed at 24 months on the right eye and at 16 months after birth on the left eye respectively. The epikeratoplasty for the traumatic cataract eye was performed at 28 months after birth. The 3 grafts have remained successful over the follow-up period of 4 to 6 years. The right eye of congenital cataract case had myopic shift of 3.75D and best corrected visual acuity of 0.2 during 5-year of follow-up period and the other left eye had myopic shift of 4.75 D and best corrected visual acuity of 0.7 during 6-year of follow-up period. The traumatic cataract case had myopic shift of 1.0 D and best corrected visual acuity of 0.05 during 4-year of follow up period. In view of this, it is considered that the epikeratoplasty is of an effective treatment in correcting the refractive error in the pediatirc aphakia patients who intolerable to contact lens and in whom difficulty exists in determining whether an intraocular lens implantation is appropriate or not.
Aphakia* ; Cataract ; Cataract Extraction ; Contact Lenses ; Epikeratophakia* ; Eyeglasses ; Follow-Up Studies* ; Humans ; Lens Implantation, Intraocular ; Parturition ; Refractive Errors ; Transplants ; Visual Acuity

To investigate the effect of disposable contact lenses (CL) on the corneal epithelial healing, a prospective study of 30 myopic epikeratoplasties which were divided into 3 groups according to the method for promoting the corneal epithelial healing was conducted. The groups are consisted of 10 eyes with pressure patch, 10 eyes with Acuvue(R) disposable CL and 10 eyes with SeeQuence(R) disposable CL. Corneal epithelial healing was completed in the pressure patch, Acuvue(R) CL and SeeQuence(R) CL group at 3.4, 3.5 and 3.4 postoperative days, respectively. Corneal epithelial healing rate during postoperative 1, 2 and 3 days are 0.33, O.78, and O.44mm2/hour in pressure patch group, O.24, O.92 and O.37mm2/hour in Acuvue(R) CL group, and O.30, O.79 and O.38mm2/hour in SeeQuence(R) CL group respectively. From the above results, it is concluded that there was no statistically significant difference of the corneal epithelial healing time and rate between the pressure patching and disposable bandage CL wearing after myopic epikeratoplasty.
Bandages* ; Contact Lenses* ; Epikeratophakia* ; Prospective Studies

The patients initially underwent epikeratoplasty for keratoconus but a penetrating kerato plasty was required due to the opacity in the cornea. By using of this specimen, which was obtained by trephination the healing process of the host-Ienticule cornea could be examined by electron microscopy and immunofluorescence method. Epithelial ingrowth over the lenticule was well formed by the regeneration of the basement membrane over the Bowman's membrane. However, the poor attachment of the lenticule over the host corneal stroma made the interface easily separated during the sectioning processes. Electron microscopic study revealed the keratocytes in the lenticule stroma vacuolized with large number of degenerated microorganelles. These results suggest that it may take a long time to complete the wound healing of the host-Ienticule interface despite the epithelial ingrowth onto the lenticule was well formed.
Basement Membrane ; Bowman Membrane ; Cornea ; Corneal Stroma ; Epikeratophakia* ; Extracellular Matrix ; Fluorescent Antibody Technique ; Humans ; Keratoconus ; Microscopy, Electron ; Regeneration ; Trephining ; Wound Healing

Trephination was performed for the purpose of correction of undercorrection after epikeratoplasty. We classified two group-Delayed regression group represented regression toward myopia more than 3D again after spherical equivalant become stable. Undercorrection group represented remained myopia after epikeratoplasty. Thirteen trephinations were performed on eleven eyes. Mean follow-up period was 22.4 weeks. In skiascopy, totally 1.15D myopia was decreased. In delayed regression group myopia was increased 0.5D, while in undercorrection group, myopia was dereased 3.5D, The results of three eyes in eleven eyse were satisfactory. Those 3 cases were from undercorrection group. The results suggest that trephination might be effective method for correction of remained myopia in undercorrection group.
Epikeratophakia* ; Follow-Up Studies ; Myopia ; Retinoscopy ; Trephining*

For the treatment of undercorrection after myopic epikeratoplasty, early suture removal, scar revision, retrephination, replacement of lenticule and, recently, excimer laser photorefractive keratoplasty have been employed. We performed trephination with Hessburg-Barron vacuum trephine on 11 eyes of 11 patients whose post-epikeratoplasty myopic power was over -4.00 diopters for 3 consecutive months. Patients were followed up on post-trephination 1 month, 3 months and 6 months. The mean duration from epikeratoplasty to trephination was 14.27 months, the mean pre-trephination spherical equivalent was -8.50 D and the mean keratometric reading was 40.87 D. The mean reduction of spherical equivalent was -4.07, -5.99, -8.02 D at post-trephination 1, 3, 6 months, respectively. The mean keratometric reading was 37.60 diopters at 1 month and 41.53 diopters at 6 months. At 1 and 3 months, there were significant reductions of myopic power in refraction and keratometry (p < 0.01), but, at 6 months, regression to pre-trephination levels took place (p > 0.05). There was no change of uncorrected and best corrected visual acuity between baseline and post-trephination 6 months.
Adult ; Epikeratophakia/instrumentation/*methods ; Female ; Follow-Up Studies ; Humans ; Male ; Myopia/etiology/*surgery ; Refraction, Ocular ; Reoperation ; Visual Acuity

We have performed epikeratoplasty to correct the visual acuity in high myopia who are more than -8.0D and intolerant to the wearing of contract lens, and for the aphakic eyes. It has been also applied to supress the progression of keratoconus. Of 118 eyes performed from january 1989 to july 1992, a total of 90 eyes which could be followed up were subject to the review, including 66 high myopic eyes, 18 keratoconus, and 6 aphakic eyes. In myopic patients, uncorrected visual acuity was stable from a proeperative mean of 0.04 to 0.58 at 4 months. Spherical equivalent was stable from a preoperative mean of -13.99 to -2.01 at 4 months. In keratoconus patients with mean 10.1 months follow-tp, uncorrected visual acuity was changed from 0.05 to 0.33 Corrected viaual acuity was changed from 0.15 to 0.60, keratometry reading was changed from 55.87D to 45.92D. Of 6 aphakic eyes, spherical equivalent of 3 pediatric: aphakic eyes under the age of 3 was changed from +15.0D to +3.41, for the other 3 adult aphakic eyes, spherical equivalent was changed from +9.5D to +1.83D and uncorrected visual acuity was changed from 0.03 to 0.32. Epikeratoplasty is effective surgery applicable to the correction of myopia more than -8.0D, keratoconus, and aphakia.
Adult ; Aphakia* ; Epikeratophakia* ; Humans ; Keratoconus* ; Myopia* ; Visual Acuity

It has been widely accepted due to its simplicity, safety and effectiveness to correct high myopia by epikeratoplasty. We evaluated clinical results of 23 cases of myopic epikeratoplasty over one year follow up. The uncorrected visual acuity improved in all cases and corrected visual acuity improved in 20 cases (91%). But, in 5 cases (22%), we experienced progressive loss of lenticular power more than 4 diopter of emmetropia and their clinical courses were also reviewed Two cases were both eyes of the same patient. The loss of lenticular power appeared as early in 5th week and even in 6th month postoperatively. We could not find any differences between this grolp of power loss and that of remained well corrected within 4 diopter of emmetropia, except preoperative spherical equivalent (-19 diopter vs -15 diopter), period of reepithelization (8.2 days vs 5.9 days), and mean age (25.8 years vs 31.1 years). But, only the difference of mean age was statistically significant (p<0.05). In addition, the surgical techniques the process of manufacturing tissue lenticule, and postoperative care might be document2d as possible factors.
Emmetropia ; Epikeratophakia* ; Follow-Up Studies ; Humans ; Myopia ; Postoperative Care ; Visual Acuity

After the first description of epikeratoplasty for the correction of aphakia, it has been widely used in high myopia and keratoconus for improvement of visual acuity. Seven epikeratoplasties were performed on five high myopia and two keratoconus patients showing intolerance to eye-glasses and contact lens, with the mean follow-up period of 9.7 months. In high myopia, mean spherical equivalent decreased from -15.90D to -2.05D postoperatively. In keratoconus, mean keratometric value decreased more than 4.94D postoperatively and the progression of disease stopped. All patients showed an imporvement in thei uncorrected visual acuity and best corrected visual acuity. In all cases, reepithelialization completed in 4-23 days (mean 14 days).
Aphakia ; Epikeratophakia* ; Follow-Up Studies ; Humans ; Keratoconus ; Myopia ; Visual Acuity