Intraepikeratophakia.

A refractive keratoplasty technique has been devised where the donor lenticule is placed between Bowman's membrane and the epithelial layer. We have termed this operation "intraepikeratophakia." The technique is based on the same principles as keratophakia. The epithelium is removed surgically and reapproximated over the transplanted lenticule. Twenty-two patients underwent conventional epikeratophakia, and ten underwent intraepikeratophakia. Of the 32 patients in this study, three required removal of the donor lenticule. All of these patients were in the epikeratophakia group, and all failures were secondary to poor reepithelialization of the lenticule. Of the ten patients who underwent intraepikeratophakia, nine had complete reepithelialization by the second postoperative day. On the average, these patients required 77% less time to reepithelialize completely compared with epikeratophakia patients. Patients in the intraepikeratophakia group were also more comfortable throughout their postoperative course probably as a result of the faster rate of reepithelialization. Intraepikeratophakia offers definite advantages over epikeratophakia and is a viable alternative to patients requiring refractive keratoplasty.