REVIEW  MODERN TECHNIQUES OF LAMELLAR KERATOPLASTY 

Minerva Oftalmologica 2018 December;60(4):207-18

DOI: 10.23736/S0026-4903.18.01816-0

Copyright © 2018 EDIZIONI MINERVA MEDICA

language: English

Mushroom keratoplasty

Vincenzo SCORCIA ✉, Giovanna CARNOVALE SCALZO, Donatella BRUZZICHESSI, Lorenzo M. VERGATI, Mauro SODA

Department of Ophthalmology, Magna Græcia University, Catanzaro, Italy

We review the indications, outcomes, procedures and complications of mushroom-shaped penetrating keratoplasty (PK) performed in eyes affected by corneal stromal opacity with the endothelium involved. PK has been performed for decades, and its pros and cons have been found and are now well-known. Its main limitations are related to refractive outcomes, wound healing and immunological rejection jeopardizing the whole graft. Mushroom PK design aims to minimize replacement of recipient healthy endothelium (typically keratoconic eyes) while providing the recipient with a large diameter of the superficial, refractive part of the graft, thus optimizing the postoperative refractive result. Mushroom PK does not require further skills compared to conventional PK, and dedicated instrumentation is limited to a microkeratome; it allows to achieve smooth interface between anterior and posterior lamellae. In mushroom PK the particular design of the surgical wound creates a wider area of contact between donor and recipient tissue, which allows faster healing and higher resistance to stress or trauma, while the smaller amount of transplanted endothelium lowers the risk of immunological rejection. Two-piece, microkeratome-assisted mushroom PK is a relatively simple procedure designed to provide the refractive advantages of a large anterior lamellar keratoplasty (LK) and those related to minimal endothelial transplantation via a small posterior LK. Visual and refractive results compare favorably with those obtained after conventional PK. Further studies involving more surgeons operating on a larger number of eyes with long-term follow-up are required to confirm initial results and further validate the use of mushroom PK.

KEY WORDS: Corneal transplantation - Penetrating keratoplasty - Ophthalmologic surgical procedures