Graft survival after mushroom-shaped keratoplasty in eyes at high risk of immunologic graft rejection: 5 year results

Session Details

Session Title: Cornea Surgical II

Session Date/Time: Tuesday 16/09/2014 | 08:00-10:30

Paper Time: 08:37

Venue: Boulevard B

First Author: : P.Santorum ITALY

Co Author(s): :    Y. Nahum   S. Madi   V. Scorcia   M. Busin     

Abstract Details

Purpose:

To report the 5-year outcomes of a novel technique of 2-piece mushroom-shaped keratoplasty (MK) that minimizes endothelial replacement.

Setting:

“Villa Serena - Villa Igea” Private Hospitals, Forlì, Italy

Methods:

All eyes at high risk of immunologic graft rejection (more than 1 quadrant of deep corneal neovascularization) but with healthy endothelium undergoing MK since 2006 were included in a prospective study. The standardized MK procedure included: a. Partial thickness (about 250 µm deep) corneal trephination, 9 mm in diameter; b. Removal of the anterior stroma by means of hand dissection; c. Full-thickness trephination of the residual bed, 6 mm in diameter; d. Microkeratome-assisted dissection of the donor cornea to obtain an anterior and a posterior lamella of about the same thickness, and punching of the lamellae to a diameter of respectively 9 mm (anterior) and 6 mm (posterior); e. Positioning of the lamellae on top of each other to fit into the recipient bed; f. Suture of the anterior lamella only (double 16-bite running suture); g. Injection of BSS into the anterior chamber to make the 2 lamellae adhere. Best-corrected visual acuity (BCVA), refraction and endothelial cell density were evaluated preoperatively and yearly after surgery. Kaplan-Maier survival analysis was performed to calculate graft survival probability as well as graft rejection probability 1, 2, 3, 4, and 5 years after MK.

Results:

Seventy-six eyes were included. Follow-up at 5-years was available in 20 eyes. Indications for surgery included vascularized post-infective scars (herpetic=34, other=16), interstitial keratitis (n=4), exposure (n=3) rosacea (n=3), and chemical burn (n=2). Mean logMAR BCVA was 0.22, 0.11, 0.08, 0.05, and 0.04 respectively 1, 2, 3, 4, and 5 years after MK. As early as two-years after surgery, i.e. one-year after suture removal, mean refractive astigmatism was 3.36±1.09 D and < 4.50 D in 85% eyes, and remained substantially unchanged thereafter. Endothelial cell loss was 40%, 41%, 48% 49%, and 49% respectively 1, 2, 3, 4, and 5 years after MK. Graft survival probability was 96%, 96%, 94%, 94%, and 94% respectively 1, 2, 3, 4, and 5 years after MK. Probability of experiencing at least 1 episode of graft rejection was 3%, 4%, 7%, 7%, and 7% respectively 1, 2, 3, 4, and 5 years after MK.

Conclusions:

Two-piece MK combines the advantages of high-survival and low-rejection rates of small grafts, with the superior refractive results of large grafts. In eyes at high risk of immunologic graft rejection, outcomes of MK compare very favorably with those of conventional penetrating keratoplasty.

Financial Interest:

One or more of the authors... travel has been funded, fully or partially, by a company producing, developing or supplying the product or procedure presented