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Arch Ophthalmol. 2000;118:281-282.

Excimer laser photorefractive keratectomy (PRK) is widely used for the correction of myopia, astigmatism, and hyperopia.^1-2 It has also been used for correction of astigmatism after penetrating keratoplasty.³

Epikeratophakia has been used in the treatment of nontolerant contact lens keratoconous patients.^4-5 The epigrafts were made from machined corneal tissue that was found unsuitable for penetrating keratoplasty. Long-term follow-up of pediatric patients who underwent epikeratoplasty for optical correction of aphakia and were corrected for emmetropia revealed that later in life there is delayed myopic regression of the treated eye, which required further correction.^6-7 In their patients, Colin et al⁸ failed to correct this myopic regression with PRK. We describe our experience with PRK for correction of delayed myopic regression of epikeratophakia in 4 eyes.

Design
All procedures were performed in the cornea and refractive surgery unit of The Goldschleger Eye Institute, Sheba Medical Center, Tel-Hashomer, Israel.

Four eyes of 2 twin sisters underwent epikeratoplasty at the ages of 8 and 9 years old because of very high myopia resulting from posterior lenticonus. Postsurgical refraction was stable for 8 years, then a rapid myopic regression of the epikeratophakic lenses was observed the following year (Table 1). Instead of removing the failed epikeratophakic lenses, we performed PRK on the eyes.

View this table: [in this window] [in a new window] Refraction and Visual Acuity Results

Results
Two and a half years after PRK, the refraction in all 4 eyes is stable and the epigrafts are clear. Table 1 presents the refraction and visual acuity results for the eyes before PRK and at 3 months, 1 year, and 2 years after PRK. No haze has developed during this period. In all 4 eyes, a thin brown deposit ring was formed on the edge of the treated optical zone.

Comment
We describe herein our successful experience with PRK for regressed epikeratophakic lenses. After a follow-up of 2 years, the results were stable and the epigrafts were clear. The eyes were also stable with regard to the best-corrected visual acuity.

Colin et al⁸ reported on 5 eyes with delayed refractive regression following myopic epikeratoplasty that were treated with PRK. Although the eyes were successfully corrected for emmetropia, all of them developed substantial subepithelial haze with poor visual acuity, and the epikeratophakic lenses had to be removed. It is possible that their poor results might be related to the preexisting corneal stromal abnormalities in their patients, which were not observed in our group. Thus, PRK can effectively be used to treat epikeratophakic regressed lenses in a selected group of patients in whom both the epikeratograft and the surrounding cornea are clear. This method eliminates the need for removal of the epikeratograft and exposing the patient to the risks of successive penetrating keratoplasty.

AUTHOR INFORMATION

Hirsh Ami, MD; Solberg Yoram, MD, PhD; Cahana Michael, MD; Avni Isaac, MD
Tel-Hashomer, Israel

Corresponding author: Yoram Solberg, MD, PhD, The Goldschleger Eye Institute, Sheba Medical Center, Tel-Hashomer 52621, Israel (e-mail: solberg{at}inter.net.il).

REFERENCES
1. Seiler T, McDonnell P. Excimer laser photorefractive keratectomy: major review. Surv Ophthalmol. 1995;40:89-110. FULL TEXT | ISI | PUBMED 2. Wu HK, Remers PZ. Photorefractive keratectomy for myopia. Ophthalmic Surg Lasers. 1996;27:29-44. PUBMED 3. Campos M, Hertzog L, Garbus J, Lee M, McDonnell P. Photorefractive keratectomy for severe keratoplasty astigmatism. Am J Ophthalmol. 1992;114:429-436. ISI | PUBMED 4. Kaufman HE, Werblin TP. Epikeratophakia for the treatment of keratoconous. Am J Ophthalmol. 1982;93:342-347. PUBMED 5. McDonald MB, Koling SB, Sabir A, Kaufman HE. On-lay lamellar keratoplasty for the treatment of keratoconous. Br J Ophthalmol. 1983;67:615-618. FREE FULL TEXT 6. Arffa RC, Marelli TL. Long term follow-up of refractive and keratometric results of pediatric epikeratophakia. Arch Ophthalmol. 1986;104:668-670. ABSTRACT 7. Neumann AC, McCarty G, Sanders DV. Delayed regression of effect in myopic keratophakia versus myopic keratomileusis for high myopia. Refract Corneal Surg. 1989;5:161-166. PUBMED 8. Colin J, Sangiuolo R, Malet F, Volant A. Photorefractive keratectomy following undercorrected myopic epikeratoplasties. J Fr Ophthalmol. 1992;15:384-388. PUBMED