Study results support use of rotating corneal autograft in traumatized eyes

Washington, DC—Rotating corneal autograft offers a viable method for visual rehabilitation in highly traumatized eyes that are at risk for a poor outcome after penetrating keratoplasty (PK), said Sai Kolli, MD, at World Cornea Congress V.

Dr. Kolli presented the results from a consecutive series of 12 eyes that underwent rotating corneal autograft over a 10-year period at the Leeds University Teaching Hospital, England.

All eyes had at least 3.5 years of follow-up. The eyes fared well with respect to graft survival, visual outcome, and safety. Eleven grafts have continued to survive long-term, while in the remaining eye, the graft decompensated after 6 years but regrafting was successful.

"We know that the results of PK are poor in damaged eyes as borne out by the results of the Australian Corneal Graft Registry study that found an 80% chance of failure when PK was performed after accidental injury," Dr. Kolli said. "We believe that rotating corneal autograft provides a solution for achieving better results and we recommend it be considered as an option in these high-risk cases."

Autograft procedure

To perform a rotating corneal autograft, a trephine is used to make an eccentric cut, creating a graft that may vary in size, but is usually in the range of 7 to 8 mm in diameter. Then the graft is rotated to bring the clear area into the visual axis, and it is sutured in place just as in PK. However, with the autograft procedure, there is a lesser requirement for steroids compared with PK and steroid use is usually discontinued by 3 months. Therefore, healing is faster after the autograft compared with PK, and so suture removal can be performed earlier.

The patients in the retrospective study had a mean age of 30 years with a range from 3 to 75 years. There were four females and eight males.

In three-fourths of the eyes, trauma was the underlying cause of corneal scarring. Other etiologies included single cases each of chemical burn, infection, and congenital scarring. Preoperative visual acuity ranged from worse than counting fingers (n = 8) to 20/60.

Consistent with their history of trauma, nine patients underwent other procedures at the time of autografting, and all had IOL replacement or lensectomy and vitrectomy.

After undergoing rotating corneal autograft, three of the 12 eyes developed elevated IOP.

However, it was controlled with topical medications.

"High-risk eyes often develop glaucoma after PK either as a result of their initial injury or secondary to prolonged use of steroids after the transplant surgery," Dr. Kolli said. "With rotating corneal autograft, there is less use of steroids and so less risk for glaucoma."

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