Posters

A novel method of mushroom keratoplasty

Poster Details

First Author: S.Smitha T INDIA

Co Author(s):    J. Medhi                    

Abstract Details

Purpose:

To describe a mushroom keratoplasty technique for an eye of patient with advanced keratoconus with significant post-hydrops scarring requiring a large diameter keratoplasty. Surgery was performed in a different way than traditional mushroom keratoplasty described in literature. The surgical technique and postoperative course and possible problems with this technique will be presented.

Setting:

A case study of a 55 year old high myope with advanced keratoconus and deep corneal scar from hydrops in past was operated in a multi-speciality eye hospital and was followed up for 6 months with anterior segment OCT and evaluation at the slitlamp.

Methods:

A 9.5 mm partial trephination was performed on the donor to include the large cone and stroma dissected in a manual DALK-like fashion. A central 6.0 mm full thickness window was cut out in deep stroma and DM. Donor preparation involved removal of peripheral doughnut like rim of DM in the 10mm donor while leaving central 6 mm of donor endothelium intact corresponding to the full thickness window made on recipient. Inferior peripheral iridodomy was performed to prevent pupillary block. Interrupted sutures were used to secure graft in place and full chamber air fill were made during surgery.

Results:

On day 3 a re-bubbling was performed to appose a separation of interfaces at 3 o'clock hours along with a temporary full thickness suture at area of detachment. At 1 month OCT showed well apposed interface over 360 degrees. A clear central cornea was noted on slitlamp. The same was maintained over 6 months. The endothelial counts were 2160 at 6 months. Vision improved from finger counting preoperatively to 6/18 at 6 months. The patient had preexisting cataract in both eyes with high axial myopia.

Conclusions:

This technique may avoid the need for creating an interface at visual axis by dissecting the donor and may avoid manipulation of donor tissue as seen with traditional methods described either using microkeratome or manually thus avoiding interface haze and excess manipulation. However there may be higher rate of re-bubbling. A thinner dissection may avoid incongruency at graft host interface. There maybe a risk of synechial angle closure if the deep stromal flap does not appose with graft in post-op period. Long term followup of this case is needed. Also this method needs to be validated in more number of eyes.

Financial Disclosure:

None