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

PURPOSE To report the outcomes of two-piece microkeratome-assisted MK for eyes with full-thickness traumatic corneal scars and otherwise functional endothelium following corneal penetrating injury. DESIGN Interventional case series METHODS: : In this single-center study, 41 consecutive eyes with traumatic corneal scars that underwent two-piece microkeratome-assisted mushroom keratoplasty were evaluated. The two-piece mushroom graft consisted of an anterior lamella of 9-mm diameter and a posterior lamella of 6-mm 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 = 0.626). 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.