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With 10-year follow-up of epikeratophakia, UCVA improved, BCVA decreased

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In high myopes with 10-year follow-up after epikeratophakia, uncorrected visual acuity improved significantly, but best corrected visual acuity decreased, a retrospective study found. Patients who were unsatisfied with their vision underwent uncomplicated lenticule removal and were able to achieve acceptable vision with contact lenses or IOL implantation, the study authors noted.

Stephan L. Kaminski, MD, and colleagues at the University of Vienna, Austria, reviewed the charts of 32 eyes of 22 patients who underwent epikeratophakia for the correction of high myopia. Average patient age at the time of surgery was 43 years; mean preoperative myopia was –18.74 D. The were patients operated on between 1985 and 1989, and follow-up was at least 10 years. These 22 patients had the epikeratophakia lenticule in place throughout the follow-up period and required no additional surgery.

In the original epikeratophakia technique, sutures were removed between 1 and 3 months postoperatively; sutures that became loose were removed immediately upon discovery. Early suture removal did not have an effect on visual outcome, according to the study authors.

Mean preop uncorrected visual acuity (UCVA) improved from 20/800 to 20/80 in 24 eyes. Mean preop best corrected visual acuity (BCVA) of 20/32 increased in five eyes, whereas six eyes had no change and 18 lost at least one line of Snellen acuity. Mean preop keratometry readings decreased from 43.67 D to 37.4 D. When glare was present, mean BCVA decreased to 20/100. Seven patients (11 eyes) were extremely satisfied with their visual outcomes more than 10 years postop; four patients were not satisfied at all.

Lenticules that had been implanted without any complications remained clear without significant scarring at the graft-host interface, the authors noted.

Six lenticules were removed after the follow-up examination, mainly because of visual complaints or because of discrepancies between potential acuity meter readings and BCVA. The lenticules were removed without problems, and rigid contact lenses were fitted successfully.

“Although epikeratophakia has fallen out of favor because other methods of refractive surgery are currently available, none of the newer methods are completely reversible, such as epikeratophakia seems to be,” the authors said in the study, which is published in the November issue of Ophthalmology.