A. Epikeratophakia was first described by Luis Ruiz, M.D. in 1980 and has been called the “living contact lens”. This is, of course, a misnomer because while human tissue is used, it is by no means — alive. The procedure uses pre-lathed human corneal tissue which is ordered for the patient much like a contact lens. It is then sewn onto the patients cornea where it remains unless removed. At one time it could be ordered like a contact lens and came in a dried state — like a potato chip. Once soaked in special fluids it became clear and flexible again. The procedure has merit and finds its best indications in pediatric aphakia, keratoconus, very high myopia or better high hyperopia, and some cases of failed or over-corrected RK's.

The patient is prepped in the normal manner and is either anesthetized generally or locally with a retrobulbar. After the lid speculum is inserted, the corneal epithelium is scraped away and a special suction trephine is placed in contact with the eye and suction engaged. The action of the trephine is to produce a shallow groove in the stroma approximately 8 mm in diameter. The groove is then extended at a 10 angle out to about 9 mm. The pre-lathed tissue, is laid in place and tucked into the prepared groove. It is sutured into place with a special continuous suture pattern to prevent distortion of the tissue disk. Appropriate antibiotics and a cycloplegic are applied followed by removal of the speculum and application of a pressure dressing (Figure).

Post-operative follow-up is quite like that of KM. The recovery period is somewhat prolonged however. It can take as long as six months to recover useful vision in rare cases. In addition, some cases of reduced post-operative best corrected vision have been reported. Sutures remain in place for approximately 1 month. In the event of infection or over or undercorrection or induced astigmatism, the donor tissue can be pulled off under topical anesthesia (drops) and new tissue applied.

Predicted results are, at this juncture, extremely variable and not on a par with KM or RK. This will change with improvement in the techniques of surgery and tissue preparation. The use of heteropathic tissue has been considered but experimental work has only just begun. This surgery was removed from investigational status as of 1 March 1986 but is rarely performed today except in certain cases of keratoconus.