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 postoperative 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 pre-existing 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.

中文翻译：

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两片蘑菇角膜移植术治疗创伤性角膜瘢痕的长期结果

目的

报告 2 片微型角膜刀辅助蘑菇角膜移植术 (MK) 对角膜穿透性损伤后全层外伤性角膜瘢痕和其他功能性内皮的眼睛的结果。

设计

这是一个介入案例系列。

方法

在这项单中心研究中，对 41 只连续接受两片微型角膜刀辅助蘑菇形角膜移植术的外伤性角膜瘢痕眼进行了评估。两片蘑菇移植物由直径 9 毫米的前层和直径 6 毫米的后层组成。结果指标是最佳眼镜矫正视力 (BSCVA)、屈光散光 (RA)、内皮细胞密度和术后并发症发生率。

结果

41例中，38眼（93%）Snellen视力≥20/100，36眼（88%）≥20/60，29眼（71%）≥20/40，13眼（32%）≥ 20/25 MK 后 2 年。排除视力受损合并症的眼睛，基线 logMAR BSCVA (1.41 ± 0.73) 在前 2 年每年显着改善 ( P < 0.001)，在第 2 年达到 0.16 ± 0.13，随后保持稳定长达 10 年 ( P = .626)。5例因高度散光伤口翻修后RA超过4.5屈光度2例（5%）。1 年内内皮细胞损失为 35.1%，10 年内每年下降 2.9%。术后 7 眼观察到眼压升高，其中 6 眼已有青光眼。移植排斥和失败的 10 年累积风险分别为 8.5% 和 10%。

结论

两片式微型角膜刀辅助 MK 治疗创伤性角膜瘢痕可以实现出色的视觉康复，同时 ECL 相对稳定，免疫排斥和移植失败率低。