Mushroom shaped wound configurized penetrating keratoplasty and its customized modifications

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Mushroom shaped wound configurized penetrating
keratoplasty and its customized modifications
Hong Kyun Kim1 , Sang Hee Lee2, Won Mun Seo1. Sun
Hwa Chai1 Dept. of Ophthalmology Kyungpook
natl.univ. school of medicine1 Metro Eye Center 2
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The Shortcomings of conventional PKP

• Classic, vertical edge-to-edge wound requires
  relatively tight sutures to withstand the effect
  of intraocular pressure and it takes too long to
  achieve complete wound.
• High incidence of induced astigmatism
• The risk of wound dehiscence
• high rate of graft rejection

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Purpose

• In order to overcome the shortcomings of
  conventional penetrating keratoplasty, We
  designed the mushroom shaped wound configurized
  keratoplsty and performed in the 3 eyes
• This study is aimed to describe our new
  keratoplasty technique and its customized
  modifications for the conditions of recipients
  cornea.

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Mushroom shaped penetrating Keratoplasty

• Indication and Basic operation method
• healthy recipients peripheral endothelium with
  large stromal disease

Prepared Donor cornea
Stepwise Trephinized Recipient Cornea
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Patients and Methods

• 3 cases with full thickness corneal disease

M/36 corneal laceration, traumatic cataract
M/27 Keratoconus with healed corneal hydrops
M/40 corneal scar after lacerated wounding
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Case 1. M/36 traumatic corneal scar

• Postoperative data
• BSCVA 20/32
• Sperical equivalent 0.50D
• Keratometric astigmatism Sim Ks Astig -2.9D
• Specular microscopy
• (Noncon Robo SP-8000, Konan Medical
  inc.,Japan)

CD CV 6A
postopertive 1yr. 1400 37 57
Preop.
POD 1mo.
Sim Ks -2.9D
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Case 2.

• Postoperative data at POD 1month
• BSCVA 20/40
• Sperical equivalent 1.00D
• Keratometric astigmatism Sim Ks Astig -1.8D
• Specular microscopy
• (Noncon Robo SP-8000, Konan Medical
  inc.,Japan)

CD CV 6A
postopertive 1mo. 2077 43 40
preoperative
POD 2 weeks
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Case 3. M/40 traumatic corneal scar

• Preoperative data
• BCVA 20/1000
• Sperical equivalent uncheckable
• Keratometric astigmatism uncheckable
• Postoperative Results at POD 6mo.
• BCVA 20/80
• Sim Ks Astig -3.2D

first visit
POD 2wks
POD 1mo.
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• case 1.
• 5mo. after operation

Experimental rabbit model 1mo. after operation

• The experimental model of the operation and UBM
  finding of the patients postoperative photo
  showed stable wound configuration.
• The tight wound configuration resembles a
  butterfly clamp that traditionally used in the
  Korean wooden archtecture.
• We named our technique as Butterfly clamp
  shaped keratoplasty.

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Customized Modifications of Our Technique

• It can also be applied the proto-type
  Butterfly-clamp shaped kratoplasty and customized
  the anterior or posterior diameter of the donor
  cornea according to the recipients corneal
  status We performed Gonio-saving mushroom-shaped
  procedure for two cases of the anterior segment
  dysgenesis patients, mushroom-shaped anterior
  lamellar keratoplasty for an advanced
  keratoconus, mushroom shaped corneolimbal
  allograft for a limbal deficiency.
• The results of the modifications are closely
  being monitored.

• Gonio-saving mushroom-shaped procedure has a
  advantage that it does not touch the peripheral
  synechial sturcture. It can avoid the possible
  complications, such as postoperative hyphema,
  iris incarceration into wound, peripheral
  anterior synechiae.

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Customized Modifications of Our Technique

• mushroom ALKP
• It can reduce postoperative steepening such an
  advanced keratoconic patient.
• mushroom shaped corneolimbal allograft
• We can easily performed the corneolimbal
  allograft in the total limbal deficiency with the
  only one donor cornea.

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Conclusion

• Advantage of Mushroom Shaped Wound Configurized
  Keratoplasty
• more stable surgical wound
• fast recovery
• less irregular astigmatism
• lower donor tissue volume
• Disadvantage
• need additional machine and device
• it is not familiar to surgeon