Anatomical and functional graft survival, 10 years after epikeratoplasty in keratoconus

Purpose: To report outcomes of epikeratoplasty in keratoconus (KC), utilizing manually-prepared plano donor lenticules in terms of flattening of the cone, reduction in astigmatism and improvement in the visual acuity. Materials and Methods: Patients with KC, having visual acuity <20/200, astigmatism >12 diopters (D) but without corneal opacity underwent epikeratoplasty, using manually prepared plano donor lenticules from fresh or M. K preserved corneas, between 1990 - 2000 and followed for 10 years, were included in this report. Visual acuity slit-lamp-biomicroscopy, keratometry, and refraction were performed at 8 weeks, 12 weeks, and 6 months for all 59 patients. The same were carried out at 1 year, 5 years, and 10 years depending upon the availability of the patient for that period. Results: Of the 59 patients, only 26 were available for follow-up after 10 years. At 3 months, 1 year and 5 years, best corrected visual acuity of (BCVA) >= 20/60 were achieved in 84.7%, 84.4% and 80.3% of eyes, respectively. BCVA was 73% at 10-year follow-up, which was due to the presence of posterior subcapsular cataract (PSC). The average keratometric astigmatism and average flattening in diopters stabilized at the end of 3 months, which remained constant at 1, 5, and 10-year follow-up. The average diopter of myopia was stabilized by 1 year, which was almost same at 10 year. Graft was clear in all but 1 eye at 10 year follow-up. Conclusion: Epikeratoplasty is a useful technique for keratoconic eyes without apical scarring who fail or unable to use contact lenses.