Indications and treatment of keratoconus using epikeratophakia.

Nineteen patients with keratoconus underwent epikeratophakia by one of the authors (DSD) and were followed from 3 to 29 months. Patient selection criteria included contact lens failure, and minimal or no central corneal scarring. Uncorrected visual acuity improved by three or more Snellen lines in 13 of 19 patients (68%). Postoperatively, after more than 6 months follow-up, 81% of the patients had best-corrected visual acuity of 20/40 or better. A mean flattening of 4.73 diopters (D) occurred on keratometry readings. There was a mean decrease in refractive cylinder of 2.84 D. Spherical equivalent refraction showed a mean decrease in myopia of 4.64 D. Five patients had postoperative refractive cylinder greater than 4 D requiring relaxing incision(s). With some patients having been followed for more than 2 years, no recurrences of keratoconus have been noted. In properly selected patients, epikeratophakia can effectively be used to treat keratoconus and thus avoid potential intraocular surgical complications and immunogenic phenomena.