Ipsilateral, Nonrotational Autokeratoplasty (INRA) Enabling Cataract Surgery in Eyes With Severe Ocular Surface Disease and Corneal Opacity.

PURPOSE: In patients with severe ocular surface disease (OSD) and cornea and cataract-related vision impairment, where the risk of allograft rejection after allogeneic corneal transplantation is unacceptably high and cataract surgery impossible because of corneal opacity, cataract extraction may still offer meaningful improvement in vision-related quality of life. We describe ipsilateral, nonrotational autokeratoplasty (INRA) as option to perform open-sky cataract surgery after removal of the central cornea and prevent immune responses by placing back the original host cornea.

METHODS

This report presents 2 patients with only 1 functional eye, cataract and severe OSD (Lyell syndrome, chemical burn) undergoing INRA to enable cataract surgery as an alternative approach to visual rehabilitation, aiming to avoid high-risk corneal transplantation. Both patients had a small central zone of relative corneal clarity.

RESULTS

This is the first report of INRA for concomitant cataract surgery. Postoperatively, both visual acuity and patient-reported visual satisfaction improved. In 1 case, delayed wound healing was noted and successfully managed with standard treatments. No other severe complications, adverse events, or rejection episodes were observed.

CONCLUSIONS

Although INRA does not address corneal vision impairment, it allows effective cataract management in patients with relative central corneal clarity and otherwise very high risk for corneal allograft failure.