title: Rotational autokeratoplasty in pediatric patients for nonprogressive paracentral corneal scars.
abstract: OBJECTIVE
  To report the outcomes of ipsilateral rotational autokeratoplasty (RAK) for nonprogressive paracentral corneal opacities in children <16 years of age.
  
  
  METHODS
  Retrospective, consecutive, interventional case series.
  
  
  METHODS
  Thirty-three eyes of 33 children aged <16 years undergoing RAK for nonprogressive paracentral scars.
  
  
  METHODS
  Medical records were retrospectively reviewed for the primary etiology of corneal opacity, time of onset, duration of opacity, preoperative visual acuity, formula used for calculation of trephine size, size of the trephine used, and duration of follow-up. Any intraoperative and early and late postoperative complications were noted for all patients. Postoperative visual acuity and astigmatism were noted. Visual acuity was converted to logarithm of the minimum angle of resolution units for analysis.
  
  
  METHODS
  Primary outcome was postoperative visual acuity. Graft clarity and complications were analyzed as secondary outcomes.
  
  
  RESULTS
  The mean age at surgery was 7.2 ± 3 .9 months. The mean follow-up duration was 27 ± 37 months. The commonest etiology of corneal opacity was trauma (62.5%), followed by resolved microbial keratitis (21.9%). Postoperative visual acuity (1.25 ± 0.84) was significantly better (P<0.001) than preoperative visual acuity (2.05 ± 0.96). The mean astigmatism at last visit was 4.04 ± 2.21 diopters. Postoperative visual acuity was better in older children (β = -0.01; P = 0.03) and had a shorter delay in presentation (β = 0.02; P = 0.05). At the last follow-up, the graft was clear in 27 cases (81.25%). The cumulative probability of graft survival was 85% at 2 years and 65% at 5 years. Complications included wound leak in 4 eyes, secondary glaucoma in 2 eyes, graft infiltrate and traumatic dehiscence in 1 eye each.
  
  
  CONCLUSIONS
  Rotational is a autokeratoplasty viable alternative surgical option to allogenic keratoplasty. Graft survival at 2 years seems to be better than allogenic keratoplasty. Younger age and delay in presentation contribute to poorer visual outcomes after surgery.
  
  
  BACKGROUND
  The authors have no proprietary or commercial interest in any of the materials discussed in this article.
authors.affiliation: LV Prasad eye Institute, Kallam Anji Reddy Campus, Hyderabad, India. muralidhar@lvpei.org
authors.forename: Muralidhar
authors.initials: M
authors.lastname: Ramappa
authors.forename: Niranjan K
authors.initials: NK
authors.lastname: Pehere
authors.forename: Somasheila I
authors.initials: SI
authors.lastname: Murthy
authors.forename: Sunita
authors.initials: S
authors.lastname: Chaurasia
authors.forename: Harsha L
authors.initials: HL
authors.lastname: Rao
authors.forename: Virender S
authors.initials: VS
authors.lastname: Sangwan
mesh_terms: D000293:Adolescent; D001251:Astigmatism / Q000503:physiopathology; D002648:Child; D002675:Child, Preschool; D002921:Cicatrix / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D003318:Corneal Opacity / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival / Q000502:physiology; D006801:Humans; D007223:Infant; D015948:Keratoplasty, Penetrating / Q000379:methods*; D008297:Male; D011183:Postoperative Complications; D012189:Retrospective Studies; D012307:Risk Factors; D014182:Transplantation, Autologous; D014792:Visual Acuity / Q000502:physiology