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Letters |

Centration of Clear Zone Over the Pupil Is the Best Strategy for Rotational Autografts

David J. Harris, MD ; Jr
Arch Ophthalmol. 2007;125(7):992-993. doi:10.1001/archopht.125.7.992-b.
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In the March 2006 issue of the Archives, Afshari et al1 describe a mathematical model that they contend is useful in planning a corneal rotational autograft. They also include a demonstrative case report. I disagree with their contention and have questions about the case report itself.

The main goal of a rotational autograft is to maximize spectacle-corrected visual acuity in an eye with the following: (1) a corneal opacity contributing to poor vision, and (2) a zone of clear cornea elsewhere. This can be best achieved by relocating the center of the largest zone of clear cornea to a spot over the center of the entrance pupil. This concept combines the principles set forth by Bourne and Brubaker,2 whose method relocates the largest zone of clear cornea to a spot over the geometric center of the cornea, and Uozato and Guyton,3 who emphasize centration of surgical procedures over the entrance pupil. The location of the entrance pupil is crucial because it defines the bundle of light rays from a distant point source destined for the fovea and because the center of the entrance pupil in a traumatized eye is often more eccentric than that in a normal eye.

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Figure 1.

Right eye with a diffuse temporal corneal scar after Pseudomonas keratitis. Best-corrected visual acuity is 20/200.

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Figure 2.

The same right eye after rotational corneal autograft. Best-corrected visual acuity is 20/40.

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