Outcomes of Application Two-Piece Microkeratome-Assisted Mushroom Keratoplasty

Purpose: to evaluate outcomes and to expose possible specific complications of two-piece mushroom keratoplasty.

Patients and methods. A total of 9 patients (9 eyes) with corneal perforations and deep stromal opacities involving the Descemet membrane were undergone surgery. In all cases, preserved hypothermic corneoscleral buttons (in Borzenok– Moroz medium) for up to 5 days were used as donor material. The two-piece mushroom keratoplasty was performed using a microkeratome and vacuum trephines set in the variant proposed by M. Busin.

Results. Success survival was obtained in 78 % of patients (7 out of 9 cases). Best spectaclecorrected visual acuity (BSCVA) 1 year after surgery averaged 0.54 ± 0.20. The average of corneal astigmatism was 3.41 ± 1.89 D. Endothelial cell density in 6 months after surgery was on average 2364 ± 236/mm2, and in 1 year — 2082 ± 228/mm2. A false chamber formation between separate parts of the graft as a specific complication was detected in 2 patients on 1 day after surgery. In one case it was eliminated by air re-injecting into the ocular anterior chamber. The second patient underwent conventional PKP due to the lack of graft adaptation. In addition, 1 patient also underwent conventional PKP as a result of postoperative crystalline infectious keratopathy, which is the non-specific complication of mushroom keratoplasty.

Conclusion. The two-piece microkeratome-assisted mushroom keratoplasty is an effective method of surgical treatment of corneal perforations and deep stromal opacities involving the Descemet membrane.

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