Ipsilateral rotational autokeratoplasty for central corneal scar: An alternative to penetrating keratoplasty

A 49-year-old woman was referred to our clinic for penetrating keratoplasty. A central corneal scar involving the visual axis with high irregular astigmatism up to 15.8 D was noted. Because the scar was located mostly in the central cornea, ipsilateral rotational autokeratoplasty was suggested and performed. An 8.5-mm punch was used to trephine the cornea eccentrically and superiorly intentionally. The trephined corneal button was then rotated 150° to relocate the scar to the temporal upper part of the cornea. The graft was soon clear with a normal curvature centrally. The astigmatism was -0.5 D, the visual acuity was 20/40, and the endothelial cell loss was 2.66% 2 years after the operation. A rotational autograft carries no risk of immunological complications such as rejection associated with allografts and has lower endothelial cell loss rate. It can be an effective alternative to standard penetrating keratoplasty for some patients with central corneal scars.