Microkeratome-assisted mushroom keratoplasty with minimal endothelial replacement.

Purpose: To report the outcome of a new keratoplasty technique aimed at treating full-thickness opacities with minimal removal of recipient endothelium.

Design: Interventional case report.

Methods: A deep central scar was removed using microkeratome-assisted mushroom-shaped keratoplasty, consisting of a large anterior stromal lamella (9.0-mm in diameter) and a small posterior button (5.0-mm in diameter) including deep stroma and endothelium. Complete suture removal was performed 3 months after surgery. Visual acuity, refraction, and computerized corneal topography were evaluated pre- and postoperatively.

Results: Best spectacle-corrected visual acuity improved from 20/60 to 20/20 at 6 months postoperatively. Postoperative refraction was -2.50-1.00 x 20 degrees.

Conclusions: Microkeratome-assisted mushroom keratoplasty may offer visual and refractive advantages over conventional keratoplasty surgery. Because most of the recipient endothelium is preserved and may spread onto the posterior surface of the small donor button, graft decompensation secondary to immunologic rejection may be avoided with this technique.