Combined epikeratoplasty and homoplastic keratophakia for correction of aphakia: double curve effect.

BACKGROUND

Having used the nonfreeze Barraquer-Krumeich-Swinger set for refractive lamellar keratoplasty since January 1987, the authors found the results of this procedure to be disappointing for correction of aphakia. Insufficient refractive gains for epikeratoplasty (+39% of initial refraction at 12-month follow up) persuaded the authors to look for a more effective refractive corneal surgery technique for correcting aphakia.

METHODS

We describe a new technique consisting of the insertion of a plano-convex homoplastic donor cornea meniscus between the patient's cornea and a hypermetropic epikeratoplasty. A nonfreeze Barraquer-Krumeich-Swinger set was used to fashion the two donor lenticules. This double surgery, called the "double curve effect," because it uses two convex surfaces to increase the converging power of the cornea, has been performed in 15 eyes.

RESULTS

We report the results of 10 eyes with a 6-month follow up. The average refractive gain was +11.75 D, 90% of the needed correction. But there was a loss of approximately 46% of best spectacle-corrected visual acuity.

CONCLUSION

Three problems should be emphasized: the existence of two interfaces, the difficulty of perfectly centering the two lenticules, and the induced irregular astigmatism. Despite these problems which can reduce the level of best spectacle-corrected visual acuity, the double curve effect may offer an effective solution for treating certain cases of unilateral aphakia.