Outcome of Rotational Keratoplasty

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Abstract
Background The nature of chronic endothelial cell loss in homologous corneal graftsis still unclear. Possible causes are cell migration to the recipient bedand chronic subclinical immune reaction. Objectives To compare endothelial cell loss after autologous rotational keratoplastyand homologous keratoplasty and present the clinical outcome of patients afterrotational keratoplasty. Methods In this open prospective study, we included 7 consecutive patients whounderwent rotational keratoplasty between 1998 and 2000 in our hospital. Patientswere examined clinically every 3 months, and visual acuity, astigmatism, andendothelial cell density were evaluated. Endothelial cell densities were comparedwith endothelial cell counts of 293 homologous keratoplasties. Results Mean follow-up for autologous grafts was 39 months. Mean increase invisual acuity was 3.5 lines. Mean astigmatism was 4.75 diopters in the autologousgraft group. Mean preoperative endothelial cell density was 2058 (637 cells/mm2). Mean endothelial cell density after 1 year was 1865 (639 cells/mm2), which represents a mean ± SD cell loss of 15% ± 7.19%.At the end of follow-up, endothelial cell number after autologous graftingwas 1630 ± 622 cells/mm2. Endothelial cell loss after 1year in homologous grafts was 40% ± 21.34%. There was 1 decompensationof autologous graft in the follow-up period. Main Outcome Measure Comparison of endothelial cell count at different postoperative timepoints using nonpaired t test. Conclusions Endothelial cell loss in autologous grafts is significantly lower thanin homologous grafts, which supports the hypothesis that chronic endothelialcell loss is due to chronic subclinical immune reactions in homologous grafts.Autologous keratoplasties can lead to good functional results and can be superiorto homologous corneal grafting in suitable situations.

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