Survival of mushroom keratoplasty performed in corneas with postinfectious vascularized scars

To report the visual outcomes and graft survival rates of mushroom keratoplasty for the treatment of postinfectious corneal scars.

Prospective, noncomparative, interventional case series.

A microkeratome-assisted mushroom-shaped keratoplasty was performed in 31 eyes of 31 patients with a central vascularized full-thickness leukoma, resulting from infectious keratitis of various origin (herpes simplex virus, n = 16; bacteria, n = 10; Acanthamoeba, n = 5), with healthy endothelium. The donor graft consisted of a large anterior stromal lamella (9.0 mm in diameter and ± 250 μm in thickness) and a small posterior button (5 to 6 mm in diameter). Visual acuity, refraction, and endothelial cell density were evaluated before surgery, as well as at 12, 24, and 36 months after surgery, and the postoperative graft survival rate was evaluated.

Three years after surgery, in 26 (83.8%) of 31 patients, best spectacle-corrected visual acuity was 20/40 or better with a refractive astigmatism of 4.5 diopters or less. The endothelial cell count at the last follow-up examination averaged 1584 ± 381 cells/mm(2), with an average cell loss of 40.7% from the preoperative value. The survival rate at 3 years was 90.3%, improving to 96.7% when excluding nonimmunologic causes for graft failure.

Similarly to penetrating keratoplasty, microkeratome-assisted mushroom keratoplasty restores vision in eyes with postinfectious, full-thickness, central corneal scars. For these vascularized corneas at high risk for immunologic rejection, mushroom keratoplasty combines the visual and refractive advantages of large penetrating keratoplasty grafts with the high survival rate of small penetrating keratoplasty grafts.