Objective: 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.
Methods: 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.
Results: 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.
Conclusions: 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.