Penetrating autokeratoplasty for unilateral corneal opacification

The aim was to evaluate the efficacy of autokeratoplasty as an alternative to conventional allograft transplantation for the management of corneal blindness in patients with a healthy cornea in the fellow blind eye.

A retrospective analysis of all consecutive cases of corneal blindness that were treated with autokeratoplasty was undertaken. We describe nine cases in which the healthy, transparent cornea from a blind eye was transplanted onto the fellow eye with a favorable visual potential but an opaque cornea. The parameters evaluated were uncorrected visual acuity, best-corrected visual acuity (BCVA), endothelial cell loss, graft clarity, and complications if any.

The median age of the patients was 63 years (range 37-83 years). Intraoperative complications encountered included expulsive hemorrhage (n=1), retrieval of a corneal button unsuitable for transplantation onto the donor defect (n=1), and problems concerning sizing of the corneal graft (n=1). Glycerine-preserved cornea was used in two eyes. All the patients achieved BCVA >20/60 by 3 months postoperatively, and 8 of the 9 patients (88.9%) maintained a clear graft till the last follow-up (12 months-78 months). Endothelial cell loss of 31.4%± 6.3%, 33.2%±5.9%, 34.7%±8.2% was noted at 1, 6, and 12 months, respectively. Accelerated endothelial cell loss after three episodes of traumatic wound dehiscence was responsible for nonimmunological graft failure in one case.

Autokeratoplasty is a viable option in selected cases of corneal blindness as an alternative to conventional allograft transplantation. In the event of adverse events, a backup tissue should be available.