Epikeratophakia was developed for the correction of aphakia in adult patients unable to tolerate contact lenses and not candidates for secondary implantation of intraocular lenses, and adapted for use in infants and children with congenital and traumatic cataracts to restore vision and prevent the development of amblyopia. Plano epikeratophakia grafts have been used to treat keratoconus, and epikeratophakia lenses have been shaped to correct unilateral high myopia, and more recently for bilateral high myopia in children and adults with extraordinary amounts of optical distortion, who are contact lens and spectacle intolerant. Hundreds of children have already been saved from amblyopia and permanent visual impairment.
Our aims are to refine current techniques to speed the return of graft clarify and improve dioptric predictability, specifically 1) to improve the design of the epikeratophakia wound such that rapid visual recovery, improved dioptric predictability, and decreased astigmatism will result; 2) to compare the present method of lathing tissue grafts with two new methods, the dry state technique and the Krumeich fresh tissue technique, as well as to compare tissue stored before lathing for shorter and longer periods of time, in primate eyes in terms of rate of clearing and in terms of loss of glycosaminoglycans, which may affect transparency; 3) to determine if freeze damage to the Bowman's membrane/basal lamina complex can be avoided by the dry processing technique, as indicated by monoclonal antibodies to type IV collagen and laminin; 4) to further test the accuracy and predictability of toric epikeratophakia lenticules for the correction of high degrees of astigmatism, particularly as it pertains to the amblyopic child with meridional anisometropia; and 5) to test, by means of an analysis for prostaglandins, the reaction of the cornea to alloplastic material(s) that may be appropriate for intrastromal implantation, such that large corrections can be obtained in young infants to prevent amblyopia and in adult patients with other refractive errors. Epikeratophakia meets many of the requirements for satisfactory correction of aphakia: safety, technical simplicity, good optical potential, general applicability, and reversibility. It has restored vision to hundreds of children and adults with potentially correctable optical defects who were otherwise functionally blind, and with further refinements will provide visual rehabilitation faster and more accurately for many more.
| McDonald, M B; McCarey, B E; Storie, B et al. (1993) Assessment of the long-term corneal response to hydrogel intrastromal lenses implanted in monkey eyes for up to five years. J Cataract Refract Surg 19:213-22 |
| Frantz, J M; Gebhardt, B M; Reidy, J J et al. (1991) Immunogenicity of epikeratophakia tissue lenses containing living donor keratocytes. Refract Corneal Surg 7:141-5 |
| Reidy, J J; McDonald, M B; Klyce, S D (1990) The corneal topography of epikeratophakia. Refract Corneal Surg 6:26-31 |
| Morgan, K S; Somers, M (1989) Update on epikeratophakia in children. Int Ophthalmol Clin 29:37-42 |
| Frantz, J M; Reidy, J J; McDonald, M B (1989) A comparison of surgical keratometers. Refract Corneal Surg 5:409-13 |
| Frantz, J M; McDonald, M B; Kaufman, H E (1989) Results of penetrating keratoplasty after epikeratophakia for keratoconus in the nationwide study. Ophthalmology 96:1151-7;discussion 1157-9 |
| Morgan, K S; Collins, C C (1989) Combined cataract extraction and epikeratophakia in children. J Pediatr Ophthalmol Strabismus 26:14-20 |
| Kaufman, H E (1989) Refractive surgery: through the looking glass. Acta Ophthalmol Suppl 192:30-7 |
| Morgan, K S; McDonald, M B; Hiles, D A et al. (1988) The nationwide study of epikeratophakia for aphakia in older children. Ophthalmology 95:526-32 |
| Busin, M; Arffa, R C; McDonald, M B et al. (1988) Change in corneal curvature with elevation of intraocular pressure after radial keratotomy in the primate eye. CLAO J 14:110-2 |
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