Abstract
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 4–5 mm 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.
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Presentations: This paper was presented at the Cambridge Ophthalmological Symposium 2008.
Appendix 1
Appendix 1
Using adobe photoshop 7.0 to manipulate corneal images for ipsilateral rotational autokeratoplasty
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1
File>Open>the digital image for manipulation
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2
Crop image to include the cornea only
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3
Setup scale
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3.1. View>rulers
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3.2. Double click on rulers to change to mm scale
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3.3. Drag origin of ruler (top left) to left hand side of cornea
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4
Resize the image to scale
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4.1. Image>Image size alter document width so that horizontal diameter of the cornea matches its measured diameter (with callipers on slit lamp) or white to white of 11.5 mm (normal corneal diameter). If the image size is too small, then multiply by a factor of 10,that is, adjust to 115 mm.
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5
Select Window>Info to view the size of selections
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6
Create markers to identify the geometric centre of the cornea
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6.1. L click on rulers and drag into position using Info dialog box to ensure the position is correct
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6.2. To fine adjust ruler , click and hold Ctrl to move
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7
Open Window>layers dialogue box
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7.1. Create new layer (click arrow in top right of dialogue box to create new layer).
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7.2. Ensure background layer is not locked (otherwise selection cannot me made)
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7.3. Name new layer with the size of the graft
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7.4. Select background layer (unlocked) before selecting trephine size
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8
Select elliptical marquee tool (to simulate trephine size)
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8.1. Left click, and then hold Shift to constrain shape to a circle (trephine size)
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8.2. Choose size of the circle using the Window Info dialogue box
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8.3. Move the selected area into position with the cursors
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8.4. Copy the selection (Edit>Copy)
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8.5. Select the new layer
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8.6. Paste into the new layer (Edit>Paste)
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9
To move the new graft around to assess effect:
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9.1. Edit>Transform>Rotate
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9.2. When the position is optimal File>Save as>new size of graft
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Arnalich-Montiel, F., Dart, J. Ipsilateral rotational autokeratoplasty: a review. Eye 23, 1931–1938 (2009). https://doi.org/10.1038/eye.2008.386
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DOI: https://doi.org/10.1038/eye.2008.386
