Management of central corneal opacities using manual and femtosecond laser–assisted rotational anterior lamellar autokeratoplasty: A descriptive case series

Abstract

Background and objective

To describe the outcomes of rotational anterior lamellar autokeratoplasty (RALK) in central corneal opacities, assessing changes in visual acuity, astigmatism, and central corneal densitometry.

Patients and methods

Retrospective descriptive case series of 9 eyes with central opacities and at least 4 mm of clear peripheral cornea, treated with manual RALK or femtosecond laser-assisted RALK. Demographic and clinical variables, leucoma characteristics, surgical parameters and postoperative evolution of best-corrected distance visual acuity (BCDVA), astigmatism, and central corneal densitometry (CCD) were analyzed. Pre- and postoperative values were compared, with statistical significance set at p < 0.05.

Results

Mean age was 44.9 years (5 women, 4 men) with a mean interval to surgery of 19.8 months. Mean leucoma area was 9.73 mm², with a depth of 268.4 μm and corneal thickness of 426.3 μm. Lamellar cut depth was 280.9 μm and graft diameter 7.9 mm. Median number of sutures was 4 (range 3–16). In 5 cases, the opacity was displaced to the superior cornea. BCDVA improved from 0.17 to 0.57 (decimal scale) at one year (p = 0.008). Astigmatism decreased from 7.7 to 5.9 D (p = 0.425), and CCD from 61.1% to 25.0% (p = 0.008). Mean follow-up was 2.4 years. One herpetic recurrence and two additional surgical procedures were recorded.

Conclusions

RALK is an effective and safe technique for relocating central corneal opacities outside the visual axis and improving visual function in selected patients. Femtosecond laser assistance provides greater precision and edge congruency, which may facilitate earlier suture removal.