Long-Term Outcomes of Two-Piece Mushroom Keratoplasty for Traumatic Corneal Scars

PURPOSE: To report the outcomes of 2-piece microkeratome-assisted mushroom keratoplasty (MK) for eyes with full-thickness traumatic corneal scars and otherwise functional endothelium following corneal penetrating injury. DESIGN: This was an interventional case series. METHODS: In this single-center study, 41 consecutive eyes with traumatic corneal scars that underwent 2-piece microkeratome-assisted mushroom keratoplasty were evaluated. The 2-piece mushroom graft consisted of an anterior lamella 9 mm in diameter and a posterior lamella 6 mm in diameter. Outcome measures were best spectacle-corrected visual acuity (BSCVA), refractive astigmatism (RA), endothelial cell density, and post-operative complication rates. RESULTS: Of the 41 total cases, 38 eyes (93%) reached Snellen vision >= 20/100, 36 (88%) reached >= 20/60, 29 (71%) reached >= 20/40, and 13 (32%) reached >= 20/25 2 years following MK. Excluding eyes with vision-impairing comorbidities, baseline logMAR BSCVA (1.41 +/- 0.73) significantly improved annually during the first 2 years (P < 0.001), reaching 0.16 +/- 0.13 at year 2, which subsequently remained stable up to 10 years (P = .626). The RA exceeded 4.5 diopters in 2 cases (5%) after wound revision for high-degree astigmatism in 5 cases. Endothelial cell loss was 35.1% at 1 year, with an annual decline of 2.9% over 10 years. Elevation in IOP was observed postoperatively in 7 eyes, of which 6 had preexisting glaucoma. The 10-year cumulative risk for graft rejection and failure was 8.5% and 10%, respectively. CONCLUSION: Two-piece microkeratome-assisted MK for traumatic corneal scars can allow excellent visual rehabilitation with relatively stable ECL and low rates of immunologic rejection and graft failure. (C) 2021 Elsevier Inc. All rights reserved.