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Published on: September 17, 2014
Long-Term Outcomes of 2-Piece Mushroom Keratoplasty: A Comparative Study of Low-Risk and High-Risk Eyes
Raphael Kilian1,2,3, Andrea Taloni1,2,3, Valentino de Ruvo1,2,3
1Department of Translational Medicine, University of Ferrara, Ferrara, Italy.
Purpose:
The aim of this study was to compare the outcomes of 2-piece mushroom keratoplasty (MK) between eyes at high risk and eyes at low risk of immunologic rejection.
Methods:
This is a retrospective interventional case series including 475 eyes from 475 patients who underwent 2-piece MK, of whom 146 (30.7%) were classified as high risk of rejection (group 1) and 329 (69.3%) as low risk (group 2). Outcome measures included corrected distance visual acuity, endothelial cell count, endothelial cell loss, graft survival rate, and postoperative complications.
Results:
There was no significant difference in endothelial cell count between groups at 10 years after transplantation (754.7 ± 316.7 [95% CI: 695.1-956.6] vs. 892.3 ± 298.8 [95% CI: 757.8-969.4] cells/mm 2 , P = 0.088, respectively). Although corrected distance visual acuity was better in the low-risk group at 1 year (0.37 ± 0.30 [95% CI: 0.32-0.42] vs. 0.25 ± 0.23 [95% CI: 0.23-0.28], P < 0.001) and 5 years (0.20 ± 0.26 [95% CI: 0.15-0.27] vs. 0.14 ± 0.21 [95% CI: 0.10-0.17], P = 0.044), this difference was no longer statistically significant at 10 years (0.25 ± 0.34 [95% CI: 0.13-0.39] vs. 0.18 ± 0.25 [95% CI: 0.12-0.24] logMAR, P = 0.269, respectively). Postoperative complication rates were comparable, except for infections, which occurred more frequently in group 1 (7.5% vs. 1.5%, P < 0.001). Graft survival rates at 10 years were 80.3% for group 1 (n = 24) and 90.7% for group 2 (n = 50) ( P = 0.153).
Conclusions:
Two-piece MK provides consistent long-term outcomes in both high-risk and low-risk eyes, showing comparable visual, endothelial, and survival results. These findings highlight the potential of MK to reduce the impact of preoperative immunologic risk and expand its role in complex corneal transplantation.
Insights
Two-piece mushroom keratoplasty (MK) offers comparable long-term visual, endothelial, and survival outcomes in both high-risk and low-risk eyes for corneal transplantation. This technique demonstrates potential in managing immunologic risk and expanding complex corneal procedures.
Area of Science:
- Ophthalmology
- Corneal Transplantation
- Immunology
Background:
- Corneal transplantation is a common procedure to restore vision.
- Immunologic rejection remains a significant challenge in corneal graft survival.
- Two-piece mushroom keratoplasty (MK) is a surgical technique used in corneal transplantation.
Purpose of the Study:
- To compare the outcomes of 2-piece MK between eyes at high risk and low risk of immunologic rejection.
- To evaluate the long-term efficacy and safety of 2-piece MK in diverse patient populations.
Main Methods:
- Retrospective interventional case series of 475 eyes undergoing 2-piece MK.
- Patients were categorized into high-risk (n=146) and low-risk (n=329) groups based on rejection risk.
- Outcome measures included visual acuity, endothelial cell count, graft survival, and complications over 10 years.
Main Results:
- No significant difference in endothelial cell count at 10 years (P=0.088).
- Visual acuity was initially better in the low-risk group but became comparable at 10 years (P=0.269).
- Graft survival rates at 10 years were 80.3% (high-risk) and 90.7% (low-risk) (P=0.153); infections were more frequent in the high-risk group (7.5% vs 1.5%, P<0.001).
Conclusions:
- 2-piece MK provides consistent long-term visual, endothelial, and survival results in both high-risk and low-risk eyes.
- MK shows potential to mitigate the impact of preoperative immunologic risk in corneal transplantation.
- These findings support the expanded use of 2-piece MK in complex corneal procedures.
