Uusitalo R J, Uusitalo H M
Department of Ophthalmology, Helsinki University Central Hospital, Finland.
J Refract Surg. 1997 Jan-Feb;13(1):45-54. doi: 10.3928/1081-597X-19970101-12.
Epikeratophakia is a potentially reversible corneal surgical procedure that can correct refractive errors in children who are aphakic and poor candidates for intraocular lens implantation. The correction of aphakia in the pediatric population poses specific problems because of associated amblyopia.
The clinical records of 61 consecutive patients (82 eyes) treated for pediatric aphakia by epikeratophakia were reviewed retrospectively with a follow-up of 3 to 5 years. For the purpose of analysis, the patients were divided into seven groups.
The overall success rate for epikeratophakia was 92%, but with repeated surgery, the patient success rate was 93%. The average refractive error at 1 year was + 0.10 diopters (D). At 1 year, 68% of eyes had a refraction within 1 D of emmetropia. In these growing eyes, we documented an average myopic shift of -0.40 D during 4 years. A myopic shift occurred in 30.2% and a hyperopic shift in 9.4% of eyes. Spectacle-corrected visual acuity at 3 years showed 36% of eyes seeing 20/40 or better. Visual acuity results in different groups varied with the timing of epikeratophakia, density of amblyopia and parents' ability to maintain the patching schedule. The most encouraging results came from the treatment of monocular traumatic cataracts. In this group, 31% achieved visual acuities of 20/40 or better and 85% achieved 20/100 or better at final examination. Those with incomplete congenital cataracts also showed favorable results: 39% achieved 20/40 or better at final examination.
Follow-up of 3 to 5 years demonstrated that epikeratophakia can correct refractive errors safely and successfully in aphakic children, either as a primary procedure, or as a secondary procedure after cataract extraction.
表层角膜镜片术是一种具有潜在可逆性的角膜手术，可用于矫正无晶状体且不适合植入人工晶状体的儿童的屈光不正。由于存在弱视，小儿无晶状体的矫正存在特定问题。
回顾性分析61例（82只眼）接受表层角膜镜片术治疗小儿无晶状体的连续患者的临床记录，随访3至5年。为便于分析，将患者分为七组。
表层角膜镜片术的总体成功率为92%，但经重复手术，患者成功率为93%。术后1年平均屈光不正为+0.10屈光度（D）。术后1年，68%的眼睛屈光在正视眼1 D范围内。在这些仍在生长的眼睛中，我们记录到4年间平均近视漂移为-0.40 D。30.2%的眼睛出现近视漂移，9.4%的眼睛出现远视漂移。术后3年眼镜矫正视力显示36%的眼睛视力达到20/40或更好。不同组的视力结果因表层角膜镜片术的时机、弱视程度以及家长坚持遮盖方案的能力而异。最令人鼓舞的结果来自单眼外伤性白内障的治疗。在该组中，31%的患者最终检查时视力达到20/40或更好，85%的患者达到20/100或更好。不完全先天性白内障患者也显示出良好结果：最终检查时39%的患者视力达到20/40或更好。
3至5年的随访表明，表层角膜镜片术可安全、成功地矫正无晶状体儿童的屈光不正，可作为初次手术，也可作为白内障摘除后的二次手术。
