Ipsilateral Rotational Autokeratoplasty Research Articles

Ипсилатеральная сквозная ротационная аутокератопластика: клинический случай и обзор литературы

Purpose. To assess the features and results of post-traumatic reconstruction of the anterior part of the eye in a child with ipsilateral rotational autokeratoplasty (IRAK). Clinical case. Patient I. 5.5 years old, on the right eye performed a reconstructive surgery of the anterior part of the eye with IRAK, including synechiotomy, iridoplasty, phacoaspiration of traumatic cataract and implantation of an intraocular lens. The analysis of literature data has been carried out The restoration of the transparency of the optical axis and increase in visual functions were obtained – the diameter of the autokeratograft was 8.0 mm with a rotation angle 110°. The most preferred for IRAK are central post-traumatic corneal scars, which have a linear shape with significant areas of the transparent corneal periphery preservation. Conclusion. IRAK does not require donor material, it is recommended for limited central corneal sports, eliminates the risk of graft rejection due to incompatibility, and does not require the usage of systemic corticosteroids and immunosuppressants. IRAK is highly effective in childhood when it is necessary to perform combined reconstructive interventions such as «open sky» on the cornea, iris and lens. Key words: ipsilateral rotational autokeratoplasty, post-traumatic scars, ophthalmology reconstruction surgery.

Ipsilateral rotational autokeratoplasty for central corneal scar: An alternative to penetrating keratoplasty

A 49-year-old woman was referred to our clinic for penetrating keratoplasty. A central corneal scar involving the visual axis with high irregular astigmatism up to 15.8 D was noted. Because the scar was located mostly in the central cornea, ipsilateral rotational autokeratoplasty was suggested and performed. An 8.5-mm punch was used to trephine the cornea eccentrically and superiorly intentionally. The trephined corneal button was then rotated 150° to relocate the scar to the temporal upper part of the cornea. The graft was soon clear with a normal curvature centrally. The astigmatism was −0.5 D, the visual acuity was 20/40, and the endothelial cell loss was 2.66% 2 years after the operation. A rotational autograft carries no risk of immunological complications such as rejection associated with allografts and has lower endothelial cell loss rate. It can be an effective alternative to standard penetrating keratoplasty for some patients with central corneal scars.

Rotational Autokeratoplasty in Pediatric Patients for Nonprogressive Paracentral Corneal Scars

To report the outcomes of ipsilateral rotational autokeratoplasty (RAK) for nonprogressive paracentral corneal opacities in children <16 years of age. Retrospective, consecutive, interventional case series. Thirty-three eyes of 33 children aged <16 years undergoing RAK for nonprogressive paracentral scars. Medical records were retrospectively reviewed for the primary etiology of corneal opacity, time of onset, duration of opacity, preoperative visual acuity, formula used for calculation of trephine size, size of the trephine used, and duration of follow-up. Any intraoperative and early and late postoperative complications were noted for all patients. Postoperative visual acuity and astigmatism were noted. Visual acuity was converted to logarithm of the minimum angle of resolution units for analysis. Primary outcome was postoperative visual acuity. Graft clarity and complications were analyzed as secondary outcomes. The mean age at surgery was 7.2 ± 3 .9 months. The mean follow-up duration was 27 ± 37 months. The commonest etiology of corneal opacity was trauma (62.5%), followed by resolved microbial keratitis (21.9%). Postoperative visual acuity (1.25 ± 0.84) was significantly better (P<0.001) than preoperative visual acuity (2.05 ± 0.96). The mean astigmatism at last visit was 4.04 ± 2.21 diopters. Postoperative visual acuity was better in older children (β = -0.01; P = 0.03) and had a shorter delay in presentation (β = 0.02; P = 0.05). At the last follow-up, the graft was clear in 27 cases (81.25%). The cumulative probability of graft survival was 85% at 2 years and 65% at 5 years. Complications included wound leak in 4 eyes, secondary glaucoma in 2 eyes, graft infiltrate and traumatic dehiscence in 1 eye each. Rotational is a autokeratoplasty viable alternative surgical option to allogenic keratoplasty. Graft survival at 2 years seems to be better than allogenic keratoplasty. Younger age and delay in presentation contribute to poorer visual outcomes after surgery. The authors have no proprietary or commercial interest in any of the materials discussed in this article.

Ipsilateral Rotational Autokeratoplasty for the Management of Traumatic Corneal Scar

A 40-years-old male patient with a corneal scar secondary to perforating eye injury had undergone ipsilateral rotational autokeratoplasty in our clinics. The corneal scar involved the pupillary area. The patient had a preoperative visual acuity of counting fingers. The patient's cornea was trephined with a 0.5 mm temporal decentration. The 8.0 mm autograft was rotated approximately 180° to relocate the scar to the temporal aspect of the cornea. The final position of the corneal scar was temporal of the visual axis and central area was clear. The visual acuity at 1-, 3-, and 6-months followups was better than the first visual acuity in the patient. Ipsilateral rotational autokeratoplasty has many advantages over conventional keratoplasty. There is no risk of immunological rejection of the graft, postoperative corticosteroids are not needed as frequently, and donor cornea is not required. A rotational autograft can be a powerful alternative to conventional keratoplasty for some patients with traumatic corneal scars.

Ipsilateral rotational autokeratoplasty: a review

Corneal opacity is a major cause of monocular blindness and, after cataract, is also a leading cause of blindness worldwide. Keratoplasty techniques for the treatment of corneal opacities include deep anterior lamellar allokeratoplasty, penetrating allokeratoplasty, penetrating bilateral autokeratoplasty, and ipsilateral rotational autokeratoplasty (IRA). This review describes the indications, technique, and outcomes of IRA. IRA is only indicated for patients with a localised opacity leaving a minimum diameter of 4-5 mm of uninvolved clear cornea. For these few patients in whom the procedure is practicable, the surgery can be planned by manipulating digital images to estimate the trephine size and location and/or by the use of formulas. IRA may not provide either as good spectacle acuity or as good quality of vision as penetrating keratoplasty because of higher astigmatism and a reduced corneal pupillary clear zone, but these disadvantages are often outweighed when the risk of allograft rejection is high, as in paediatric patients and those with vascularised corneas. The main benefits of IRA are the retention of host endothelium, thereby eliminating both the risk of endothelial rejection and the prolonged attrition of endothelial cell numbers that occurs following penetrating keratoplasty, and the reduced requirement for postoperative steroid therapy with its associated complications.

Digital imaging to assist preoperative planning for ipsilateral rotational autokeratoplasty

A 14-month-old child with a central corneal scar underwent rotational autografting of his cornea to clear his visual axis. This was accomplished through eccentric trephination and 180 degree rotation of the central cornea. A preoperative image of the patient's cornea was manipulated digitally using a common commercial image-processing software package. This allowed accurate prediction of the best trephine size and location prior to surgery. Digital imaging played an important role in preoperative surgical planning and demonstrates the potential for tele-ophthalmology.

Ipsilateral rotational autokeratoplasty: an alternative to penetrating keratoplasty in nonprogressive central corneal scars.

To report the outcome of ipsilateral rotational autokeratoplasty performed for nonprogressive central corneal opacities. Medical records of 27 patients who underwent ipsilateral rotational autokeratoplasty between June 1995 and December 1998 were retrospectively reviewed. The etiology of corneal opacity, preoperative visual acuity, and size of the trephine used was noted. Any intraoperative and early and late postoperative complications were noted in all patients. The final outcome, visual acuity, and astigmatism at final correction were analyzed. The main etiology of corneal opacity was trauma (44.4%), followed by resolved keratitis (29.6%). The size of the graft ranged from 6.5 to 9 mm. Fifteen patients underwent autokeratoplasty alone; additional procedures were combined in the remaining 12. Wound leak was the most common postoperative complication, which was seen in seven patients. The mean follow-up was 12.11 months (SD = 11.95 months). Five patients (18.5%) were lost to follow-up. Of the remaining 22, 19 (86.36%) had clear grafts and 3 (13.6%) had failed grafts. The mean astigmatism at final correction was 4.25 diopters cylinder (SD = 2.72). Final visual acuity of 20/80 or better was obtained in 13 cases (59.09%). Contrary to common belief, ipsilateral rotational autokeratoplasty is a safe and effective surgical procedure. It can be considered as an alternative procedure to penetrating keratoplasty in a scenario in which tissue scarcity exists, as well as in cases that have a high risk of developing immunologic allograft rejection. Further prospective studies with preoperative specular microscopy and postoperative corneal topography will provide greater insight into the usefulness of this procedure.

Ipsilateral rotational autokeratoplasty for the management of corneal opacities.

Penetrating keratoplasty is the logical solution for the management of corneal opacities. In situations such as in Papua New Guinea, where donor corneal tissue is scarce and corneal opacities are plenty, an alternative procedure for the management of corneal opacities in the form of ipsilateral rotational autokeratoplasty was considered. In the present prospective study, ipsilateral rotational autokeratoplasty was performed in 17 eyes over a 2 year period in a general hospital. The patient's cornea was trephined eccentrically and the corneal opacity was dialed out of the visual axis and was replaced by clear peripheral cornea. Most opacities were leucomata (76.4%). The average size of the opacity was 5.1 mm and the corneal button size was 7 mm.A final visual acuity of 6/18 or better was obtained in 64.7% of cases (at 12 months). No significant postoperative complications were encountered. No complex formula was needed to calculate the size of the button and, by simply adding 3 mm to the pupillary diameter in standard illumination, one could make an estimation of the graft diameter. Rotational autokeratoplasty has a definite role in places where donor corneal tissue is scarce, in patients in whom long-term steroids are a risk or in situations where follow up of patients is difficult. Rejection is a theoretical impossibility, but late endothelial failure could occur, requiring regrafting. Rotational autokeratoplasty should be seriously considered as an alternative to conventional penetrating keratoplasty.

Rotational autokeratoplasty.

The results of sixteen patients who had undergone ipsilateral rotational autokeratoplasty are presented. Thirteen patients obtained significant visual improvement, and eight patients achieved an acuity of 6/12 or better. There were no significant pre-operative or post-operative complications. The principles of pre-operative assessment and surgery are discussed.

Keratoplasty following anterior segment trauma.

This paper reports and analyses 20 keratoplasties with or without anterior segment reconstruction carried out for penetrating injuries of the anterior segment. The results show that 80% clear grafts were achieved and 65% of eyes had vision restored to 6/18 or better. No eyes were lost. The complications were retinal detachments 2 cases, corneal graft rejection 2 cases, glaucoma 4 cases (2 mild and easily controlled) and one each of amblyopia and retinal folds through macular area. Eyes that have "quietened" following severe penetrating injuries of the anterior segment should be considered for penetrating keratoplasty and anterior segment reconstruction if they retain normal intraocular pressures and have vision of at least accurate projection of light in all quadrants. As well as achieving clear grafts and improvement of vision as above, all eyes had better cosmetic appearance. Two eyes had an ipsilateral rotational autokeratoplasty. This technique has a role to play when central scarring can be rotated to the periphery if sufficient undamaged cornea remains and interference with angle structures can be minimised.