==================================HSR48================================== 48. Safety and effectiveness of epikeratophakia. 1 UI - 87025175 AU - Arffa RC ; Busin M ; Barron BA ; McDonald MB ; Kaufman HE TI - Epikeratophakia with commercially prepared tissue for the correction of aphakia in adults. AB - The records of all adult patients at Louisiana State University Eye Center, New Orleans, who underwent epikeratophakia for aphakia with commercially prepared tissue since February 1984 were reviewed. The epikeratophakia lenticule was maintained in 37 (92.5%) of 40 patients; complications required the removal of three tissue lenses. The average refractive error three months after surgery was +0.67 +/- 1.97 diopters; 25 (90%) of 28 patients were within 3 D of emmetropia. At six months, the average refractive error was -0.18 +/- 2.27 D. Fourteen (58%) of 24 patients whose visual acuity was 20/40 or better with spectacles before surgery achieved 20/40 spectacle visual acuity three months after surgery, as did ten (59%) of 17 patients at six months and five (83%) of six patients at 12 months. The results in these recent cases are better than in previously reported series and reaffirm the usefulness of epikeratophakia in the treatment of aphakia. MH - Adult ; Aged ; Aphakia/PHYSIOPATHOLOGY/*SURGERY ; Cornea/*TRANSPLANTATION ; Human ; Lens, Crystalline/SURGERY ; Methods ; Middle Age ; Postoperative Complications ; Prospective Studies ; Support, Non-U.S. Gov't ; Support, U.S. Gov't, P.H.S. ; Time Factors ; Visual Acuity SO - Arch Ophthalmol 1986 Oct;104(10):1467-72 2 UI - 86322635 AU - McDonald MB ; Kaufman HE ; Durrie DS ; Keates RH ; Sanders DR TI - Epikeratophakia for keratoconus. The nationwide study. AB - The nationwide study of epikeratophakia for the treatment of keratoconus involved 69 surgeons in the United States; they operated on 177 eyes as of Dec 31, 1985. In this first report, the results from 35 surgeons involving 82 cases with 30 or more days of follow-up after suture removal are described. In all but two patients, uncorrected visual acuity improved; 17 patients showed improvement of three Snellen lines, and 38 patients showed improvement of four or more lines. The majority of patients' vision returned to within one line of their best corrected acuity; in 78% it was 20/40 or better postoperatively. Eight patients needed no postoperative overrefraction at all. The mean flattening by keratometry readings was 9.36 diopters, and the mean decrease in myopia in terms of spherical equivalent was 5.26 D. No significant changes in intraocular pressure or endothelial cell counts were noted. Some advantages of epikeratophakia for keratoconus over the traditional penetrating keratoplasty include the lack of serious, vision-threatening complications or permanent vision loss, the reversible nature of the surgery, and the absence of potential immunogenic rejection phenomena. MH - Adolescence ; Adult ; Cell Count ; Clinical Trials ; Cornea/SURGERY/ *TRANSPLANTATION ; Endothelium/CYTOLOGY ; Female ; Follow-Up Studies ; Human ; Intraocular Pressure ; Keratoconus/*SURGERY ; Male ; Middle Age ; Prospective Studies ; Reoperation ; Support, Non-U.S. Gov't ; Support, U.S. Gov't, P.H.S. ; Suture Technics ; Transplantation Immunology ; *Visual Acuity SO - Arch Ophthalmol 1986 Sep;104(9):1294-300 3 UI - 86214676 AU - Kelley CG ; Keates RH ; Lembach RG TI - Epikeratophakia for pediatric aphakia. AB - We used epikeratophakia for rehabilitation in 11 contact lens-intolerant aphakic children aged 9 months to 14 years. Minimum follow-up was five months; the longest was 12 months. There were no graft failures, and no patients were unavailable for follow-up. Objective postoperative overrefractions on all patients revealed that an average of 93% of the desired correction was obtained. Residual corrections ranged from -3.75 diopters spherical equivalent to +2.87 D. Nine of the 11 children were of verbal age; their spectacle visual acuities averaged 20/50, with a range of 20/20 to 20/80. Preverbal children all tolerated occlusive therapy, although accurate visual acuities could not be obtained. Our early results with this modality as therapy for monocular aphakia in the pediatric population have demonstrated improvement in visual function in all patients to date. MH - Adolescence ; Aphakia, Postcataract/PHYSIOPATHOLOGY/*SURGERY ; Child ; Child, Preschool ; Cornea/*TRANSPLANTATION ; Follow-Up Studies ; Human ; Infant ; Methods ; Refraction, Ocular ; Support, Non-U.S. Gov't ; Visual Acuity SO - Arch Ophthalmol 1986 May;104(5):680-2 4 UI - 86214674 AU - Arffa RC ; Marvelli TL ; Morgan KS TI - Long-term follow-up of refractive and keratometric results of pediatric epikeratophakia. AB - To examine the long-term stability of epikeratophakia and its effect on the development of young eyes, the change in corneal curvature and refractive error over time were reviewed in pediatric patients who underwent epikeratophakia for optical correction of aphakia. Over an average follow-up time of 28.0 months, corneal curvature flattened by 1.15 diopters, or 0.53 D/yr. The average change in refractive error was -2.81 D over 23.6 months, or 1.49 D/yr. Patients younger than 1 year of age at surgery became significantly more myopic over the period of follow-up (4.75 D) than patients older than 1 year of age at surgery (2.24 D). These changes are consistent with the corneal flattening and increase in axial length expected from normal growth. Aphakic infants corrected to emmetropia with epikeratophakia will likely require correction of myopia in later childhood. MH - Aphakia, Postcataract/PHYSIOPATHOLOGY/SURGERY ; Child ; Child, Preschool ; Cornea/ANATOMY & HISTOLOGY/*TRANSPLANTATION ; Follow-Up Studies ; Human ; Infant ; Myopia/ETIOLOGY/PHYSIOPATHOLOGY ; *Refraction, Ocular ; Support, Non-U.S. Gov't ; Support, U.S. Gov't, P.H.S. ; Visual Acuity SO - Arch Ophthalmol 1986 May;104(5):668-70 5 UI - 86204793 AU - Morgan KS ; Arffa RC ; Marvelli TL ; Verity SM TI - Five year follow-up of epikeratophakia in children. AB - 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. MH - Cataract/CONGENITAL ; Cataract Extraction ; Child ; Child, Preschool ; Cornea/*TRANSPLANTATION ; Evaluation Studies ; Follow-Up Studies ; Human ; Infant ; Postoperative Complications ; Refraction, Ocular ; Refractive Errors/PHYSIOPATHOLOGY/SURGERY ; Reoperation ; Support, Non-U.S. Gov't ; Support, U.S. Gov't, P.H.S. ; Surgical Wound Infection ; Visual Acuity SO - Ophthalmology 1986 Apr;93(4):423-32 6 UI - 86102761 AU - Robin JB ; Gindi JJ ; Koh K ; Schanzlin DJ ; Rao NA ; York KK ; Smith RE TI - An update of the indications for penetrating keratoplasty. 1979 through 1983. AB - We performed a retrospective analysis of the clinical and pathologic diagnoses of 497 corneal buttons that had been submitted to the Estelle Doheny Eye Pathology Laboratory, Los Angeles, during the five-year period 1979 through 1983. The leading indications, in order of decreasing frequency, were pseudophakic bullous keratopathy (17.5%), regrafts (15.1%), aphakic bullous keratopathy (10.9%), corneal trauma (9.3%), and Fuchs' endothelial dystrophy (9.1%). The emergence of pseudophakic bullous keratopathy as the most common cause for penetrating keratoplasty correlates well with the dramatic increase in the number of cataract extractions with intraocular lens implantations performed since the mid-1970s. Less frequent indications for penetrating keratoplasty included the following: corneal scars (6%); active ulcerative keratitis (7%); keratoconus (6%); keratitis secondary to virus (5%); non-Fuchs' corneal dystrophies (3%); congenital corneal opacities (3%); interstitial keratitis (2%); and chemical burns (1%). MH - Adolescence ; Adult ; Aged ; Cataract Extraction/ADVERSE EFFECTS ; Child ; Child, Preschool ; Cornea/*SURGERY/TRANSPLANTATION ; Corneal Diseases/ SURGERY ; Female ; Human ; Infant ; Infant, Newborn ; Keratoconus/SURGERY ; Lenses, Intraocular/ADVERSE EFFECTS ; Male ; Middle Age ; Ophthalmology/ *TRENDS ; Postoperative Complications/SURGERY ; Support, Non-U.S. Gov't SO - Arch Ophthalmol 1986 Jan;104(1):87-9