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 4-5mm 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. Eye (2009) 23, 1931-1938; doi:10.1038/eye.2008.386; published online 9 January 2009