Simultaneous Corneal Allograft and Contralateral Corneal Autograft: A Case Report

Introduction: Autologous contralateral autograft has been described as a useful procedure in patients who require penetrating keratoplasty on their only functional eye and have a clear cornea on their nonfunctional eye due to the low chances of graft rejection in autografts. Here we describe a case where we were able to salvage vision by corneal autografting in a blind patient. Case: A 65-year-old male had blurred vision in both eyes with visual acuity of perception of light (PL) in right eye (RE) and hand motion (HM) in left eye (LE). On examination, RE had a clear cornea, sluggish pupillary reaction with presence of Relative afferent pupillary defect and glaucomatous optic atrophy. Left eye had a corneal opacity following healed corneal ulcer. RE Penetrating Keratoplasty (PK) using an allograft and left eye PK using the contralateral autograft was done. Post-operatively, RE developed persistent epithelial defect and eventually failed after 2 months while the left autograft got fully epithelialized and remained clear till 2 years follow up even after steroids were stopped. Conclusion: Autokeratoplasty have higher chances of graft survival due to the absence of immune graft rejection and resultant postoperative endothelial cell loss. Hence, it may be considered first in any case where there is this unique combination of opaque cornea in an eye with better visual potential and a clear cornea in an eye without visual potential.