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—The reasons for prolonged visual recovery in epikeratoplasty compared with penetrating keratoplasty for keratoconus are multifactorial and not well understood currently. Sutures must be retained for at least three months, and commonly four or five months, after the epikeratoplasty procedure. The sutures must be tight and, accordingly, high degrees of irregular astigmatism can be expected until suture removal is complete. After that time, it is attractive to hypothesize that the ongoing slow improvement in acuity corresponds to the slow repopulation of the lenticular stroma by the patient's keratocytes migrating from the periphery. Other simultaneous variables include healing of the annular keratectomy wound, partial relaxation of the compressed underlying host cornea, and remodeling of the surface epithelium. Although all of our patients were young adults with otherwise healthy eyes, there was considerable variance in the rapidity of visual recovery, with one patient achieving a visual acuity of 20/30 by
Steinert RF, Wagoner MD. Shortened Recovery From Keratoplasty and Epikeratoplasty-Reply. Arch Ophthalmol. 1989;107(2):167. doi:10.1001/archopht.1989.01070010173006