Epikeratophakia continues to be an extremely attractive option for younger children with unilateral
aphakia who are noncompliant users of
contact lenses but who are young enough to benefit from
amblyopia therapy. The
epikeratophakia procedure is much safer than IOL implantation. The
epikeratophakia tissue lens is especially useful for children with traumatic
aphakia and corneal
lacerations because the lens can strengthen and smooth the cornea as well as correct the
aphakia. This allows much quicker rehabilitation than could be accomplished with
contact lenses. The
epikeratophakia procedure may be combined with a
cataract extraction and should be in those children with acquired
cataracts who demonstrate
contact lens noncompliance in an office trial of
contact lens insertion before operation.
Epikeratophakia should be used with caution in neonates and young infants because of the rapid growth of the eye.
Extended-wear contact lenses are a safer option for these children, and
epikeratophakia can be performed as a secondary procedure if and when problems with
contact lens compliance arise. Surface ocular problems such as uncontrolled
dry eyes or severe
blepharitis will continue to be incompatible with the survival of
epikeratophakia tissue
lenses. Children who are treated with high doses of radiation for orbital
tumors such as
rhabdomyosarcomas invariably develop radiation
cataracts, which can occur before the onset of radiation
keratitis. These children do not do well with
epikeratophakia tissue
lenses. Likewise, children with severe metabolic disturbances who are not healthy or gaining weight have a diminished chance of graft healing, as do children with poor vision in whom oculodigital autostimulation produces persistent epithelial defects, which prevent survival of the tissue lens.(ABSTRACT TRUNCATED AT 250 WORDS)