Ipsilateral rotational autokeratoplasty for the management of corneal opacities.

PURPOSE/BACKGROUND: Penetrating keratoplasty is the logical solution for the management of corneal opacities. In situations such as in Papua New Guinea, where donor corneal tissue is scarce and corneal opacities are plenty, an alternative procedure for the management of corneal opacities in the form of ipsilateral rotational autokeratoplasty was considered. METHODS: In the present prospective study, ipsilateral rotational autokeratoplasty was performed in 17 eyes over a 2 year period in a general hospital. The patient's cornea was trephined eccentrically and the corneal opacity was dialed out of the visual axis and was replaced by clear peripheral cornea. RESULTS: Most opacities were leucomata (76.4%). The average size of the opacity was 5.1 mm and the corneal button size was 7 mm.A final visual acuity of 6/18 or better was obtained in 64.7% of cases (at 12 months). No significant postoperative complications were encountered. No complex formula was needed to calculate the size of the button and, by simply adding 3 mm to the pupillary diameter in standard illumination, one could make an estimation of the graft diameter. CONCLUSIONS: Rotational autokeratoplasty has a definite role in places where donor corneal tissue is scarce, in patients in whom long-term steroids are a risk or in situations where follow up of patients is difficult. Rejection is a theoretical impossibility, but late endothelial failure could occur, requiring regrafting. Rotational autokeratoplasty should be seriously considered as an alternative to conventional penetrating keratoplasty.

Intraoperative use of mitomycin C in the treatment of recurrent pterygium.

The prevalence rate of pterygium in Papua New Guinea (PNG) is as high as 15%. Recurrence rates up to 50% are encountered after primary excision. In a country such as PNG where resources in terms of funds and manpower are limited, a simple procedure had to be identified to reduce this alarmingly high rate of pterygium recurrence. This article compares the results of a randomized masked study involving the single intraoperative application of 0.02% mitomycin C solution in 65 eyes undergoing surgery for recurrent pterygium using the bare sclera technique with a similar group of 65 patients in which the drug was not used. The results indicate that a single intraoperative application of mitomycin C solution was enough to reduce the recurrence rate of pterygium to 3% in the treated group as compared to 48% in the untreated group at the end of a 12-month follow-up. In the study it was also seen that, in PNG, pterygia were more common in females and that recurrences tended to occur early and were obvious in the first few weeks following surgery.