Anatomical and Functional Outcomes of Rotational Autokeratoplasty in Children: A Multicenter Retrospective Study

The purpose of this study was to report the indications and long-term anatomical and functional results of a series of children operated on by ipsilateral rotational autokeratoplasty.

This retrospective, multicenter study was based on the medical records of 33 eyes of 31 children who underwent ipsilateral rotational autokeratoplasty in 2 pediatric ophthalmology departments in Paris. The etiology of corneal opacity, preoperative and postoperative visual acuity, size of the trephine used, postoperative complications, refractive error, and duration of follow-up was retrieved. Visual acuity (VA) was converted to logarithm of the minimum angle of resolution.

The most frequent indications were corneal scars after ocular trauma (21 cases, 64%), congenital corneal opacities (9 cases, 27%), and postinfectious scars (3 cases, 9%). At last follow-up, 97% of the eyes had a clear visual axis. The mean postoperative VA was 0.83, and mean postoperative astigmatism was 5.41 diopters. When available, VA of the operated eye was equal to or better than 0.3 logarithm of the minimum angle of resolution in 8 cases (32%). The factors significantly associated with a postoperative VA of 0.3 or better were a later age of onset of the opacity ( P < 0.01), a later age at surgery ( P < 0.01), and a posttraumatic mechanism ( P = 0.03). A postoperative complication was found in 13 patients (40%), and consisted most frequently in a wound leakage and/or iris hernia in the early postoperative period.

Ipsilateral rotational autokeratoplasty is an excellent alternative to penetrating keratoplasty in children because the anatomical result seems better and the complication rate less important than in pediatric penetrating keratoplasty, where graft rejection occurs frequently.