Corneal Autograft Procedures

The greatest advantage of a corneal autograft is the elimination of allograft rejection. Cases with clinical circumstances appropriate for autograft are uncommon, but an astute ophthalmologist who recognizes the potential for a successful autograft procedure can spare the patient the risks associated with long-term topical steroid use and the need for lifelong vigilance against rejection.

A rotational autograft can be used to reposition a localized corneal scar that involves the pupillary axis. By making an eccentric trephination and rotating the host corneal button before resuturing, the surgeon can place a paracentral zone of clear cornea in the pupillary axis. The procedure is particularly useful in children, in whom the prognosis for PK is poorer, and in areas with tissue scarcity. It is important that the graft–host junction not be too close to the visual axis, because image distortion and irregular astigmatism could result.

A contralateral autograft is reserved for patients who have a corneal opacity in one eye with a favorable visual prognosis, and a clear cornea in the opposite eye with coexisting severe dysfunction of the afferent system (eg, retinal detachment, severe amblyopia). The clear cornea is transplanted to the first eye; then, it is replaced with either the diseased cornea from the first eye or an allograft. If an eye with a clear cornea is to be enucleated or eviscerated, the cornea can be used as a donor for keratoplasty in the fellow eye. Such simultaneous bilateral transplant surgery carries the risk of bilateral endophthalmitis.

Excerpted from BCSC 2020-2021 series: Section 10 - Glaucoma. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.