Rotational Autokeratoplasty As Management Of Extreme Astigmatism After Penetrating Keratoplasty

To describe the anatomic and functional results of ipsilateral rotational autokeratoplasty (IRA) as a treatment option for patients with extreme astigmatism after penetrating keratoplasty (PK).

Patients with extreme astigmatism after penetrating keratoplasty that underwent IRA from 2010 to 2023 by the same surgeon, and were followed up for a minimum of 12 months postoperatively at Fundación Oftalmológica Nacional (Bogotá), an ophthalmology reference center for corneal transplantation in Colombia.

Descriptive observational study. The surgical technique is the same as described by other authors for IRA as management for corneal opacities. In this surgical approach, the original PK trephination diameter was maintained, the corneal graft was rotated 90 degrees clockwise and then resutured. Sutures were removed after 18-24 months to warrant wound stability and complete healing.

We reviewed electronic health records (EHR) of patients that underwent this approach, including pre and postoperative uncorrected distance visual acuity (UCDVA), corrected or pinhole visual acuity when available, keratometric astigmatism, corneal topography when available, time from PK to IRA, and endothelial cell count when available.

A total of 12 eyes (11 patients) were included in the study. The median age was 49 years old (range 26-62). Of the 11 patients, 7 were male and 5 were female. The average elapsed time from the PK to the IRA was 12,88 years (range 0,5-38). UCDVA was 1,69 LogMAR preoperatively (SD 0,37) and 0,83 LogMAR postoperatively (SD 0,52). Mean astigmatism was 14,77 D preoperatively (SD 3,7) and 3,68 D postoperatively (SD 2,2). Endothelial cell count before the retrephination and IRA was found in the EHR of 8 eyes with an average of 999,87 (range 714-1934), and postoperatively in 5 eyes with an average of 849,66 (range 676-1257) cells/mm2.

IRA is available as a treatment option for cases of extreme astigmatism after PK, with the advantages of being a surgical technique already familiar to the cornea specialist, while using the corneal graft that’s already in place reducing the need to regraft and the patient sensitization to another donor’s tissue. We found important reductions of astigmatism and improvements in UCDVA that will finally benefit the patients who had severe visual impairment associated with extreme astigmatism.