Five year follow-up of epikeratophakia in children.

Epikeratophakia alters the anterior curvature of the cornea by the addition of a machine-carved donor lenticule. Since March 1980, 88 patients under eight years of age have had epikeratophakia, with at least six months of follow-up. Eighty percent of the original surgeries were successful; some failed grafts were replaced successfully, so that in all, 89% of the patients had successful grafts. The average increase in curvature of the cornea was 14.7 diopters, and the average spectacle overcorrection was +0.56 diopters. In these growing eyes, we documented a myopic shift of 1.5 diopters per year. Visual acuity results varied with the timing of refractive surgery, density of the amblyopia, and the parents' ability to maintain the patching schedule. The largest group of children were those who had unilateral traumatic cataracts. In this group, 7 of 15 patients who had surgery under 4 years of age had final verbal acuities of 20/40 or better. Long-term follow-up has demonstrated that epikeratophakia safely and successfully corrects refractive errors in aphakic children either as a primary procedure, or as a secondary procedure after cataract extraction.