2020–2021 BCSC Basic and Clinical Science Course™
13 Refractive Surgery
Chapter 4: Onlays and Inlays
Epikeratoplasty involved suturing a preformed homoplastic lenticule directly onto the Bowman layer of the host cornea. Because no viable cells existed in the donor tissue, classic graft rejection did not occur. Epikeratoplasty was originally intended to create a “living contact lens” for patients with aphakia who were unable to wear contact lenses. Indications for this procedure were later expanded to include hyperopia, myopia, and keratoconus, but problems such as adherence of the grafted tissue, infection, epithelial ingrowth into the bed, poor predictability of results, and corneal edema have relegated epikeratoplasty to a historical footnote. In treating patients with these conditions, surgeons need to approach corneal refractive surgery with caution.
Werblin TP, Kaufman HE, Friedlander MH, Sehon KL, McDonald MB, Granet NS. A prospective study of the use of hyperopic epikeratophakia grafts for the correction of aphakia in adults. Ophthalmology. 1981;88(11):1137–1140.
Excerpted from BCSC 2020-2021 series: Section 13 - Refractive Surgery. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.