title: A Two-Piece Microkeratome-Assisted Mushroom Keratoplasty Improves the Outcomes and Survival of Grafts Performed in Eyes with Diseased Stroma and Healthy Endothelium (An American Ophthalmological Society Thesis).
abstract: To test the hypothesis that a new microkeratome-assisted penetrating keratoplasty (PK) technique employing transplantation of a two-piece mushroom-shaped graft may result in better visual outcomes and graft survival rates than those of conventional PK.
  
  
  
  Retrospective chart review of 96 eyes at low risk and 76 eyes at high risk for immunologic rejection (all with full-thickness central corneal opacity and otherwise healthy endothelium) undergoing mushroom PK between 2004 and 2012 at our Institution. Outcome measures were best-corrected visual acuity (BCVA), refraction, corneal topography, endothelial cell density, graft rejection, and survival probability.
  
  
  
  Five years postoperatively, BCVA of 20/40 and 20/20 was recorded in 100% and over 50% of eyes, respectively. Mean spherical equivalent of refractive error did not vary significantly over a 5-year period; astigmatism averaged always below 4 diopters, with no statistically significant change over time, and was of the regular type in over 90% of eyes. Endothelial cell density decreased to about 40% of the eye bank count 2 years after mushroom PK and did not change significantly thereafter. Five years postoperatively, probabilities of graft immunologic rejection and graft survival were below 5% and above 95%, respectively. There was no statistically significant difference in endothelial cell loss, graft rejection, and survival probability between low-risk and high-risk subgroups.
  
  
  
  Refractive and visual outcomes of mushroom PK compare favorably with those of conventional full-thickness keratoplasty. In eyes at high risk for immunologic rejection, mushroom PK provides a considerably higher probability of graft survival than conventional PK.
authors.affiliation: Department of Ophthalmology, "Villa Igea-Villa Serena" Private Hospitals, Forlì, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Busin
authors.affiliation: Department of Ophthalmology, Alexandria University, Alexandria, Egypt.
authors.forename: Silvana
authors.initials: S
authors.lastname: Madi
authors.affiliation: Department of Ophthalmology, University of Magna Graecia, Catanzaro, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Scorcia
authors.affiliation: Department of Ophthalmology, "San Maurizio" Central Regional Hospital, Bolzano, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Santorum
authors.affiliation: Department of Ophthalmology, Rabin Medical Center, Beilinson Campus, Petah Tikvah, Israel, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Yoav
authors.initials: Y
authors.lastname: Nahum
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D055954:Corneal Endothelial Cell Loss / Q000209:etiology; D003318:Corneal Opacity / Q000503:physiopathology / Q000601:surgery*; D019781:Corneal Topography; D004728:Endothelium, Corneal / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000209:etiology; D006801:Humans; D053208:Kaplan-Meier Estimate; D015948:Keratoplasty, Penetrating / Q000295:instrumentation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012029:Refraction, Ocular / Q000502:physiology; D012189:Retrospective Studies; D014481:United States; D014792:Visual Acuity / Q000502:physiology; D055815:Young Adult