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 Kim 1 , Sang Hee Lee 2 , Won Mun Seo 1. Sun Hwa Chai 1 Dept. of Ophthalmology Kyungpook natl.univ. school of medicine 1 Metro Eye Center 2. The Shortcomings of conventional PKP.

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mushroom shaped wound configurized penetrating keratoplasty and its customized modifications

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

the shortcomings of conventional pkp
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
purpose
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 recipient’s cornea.

mushroom shaped penetrating keratoplasty
Mushroom shaped penetrating Keratoplasty

Indication and Basic operation method

healthy recipient’s peripheral endothelium with large stromal disease

Prepared Donor cornea

Stepwise Trephinized Recipient Cornea

patients and methods
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

case 1 m 36 traumatic corneal scar
Case 1. M/36 traumatic corneal scar

Postoperative data

  • BSCVA 20/32
  • Sperical equivalent +0.50D
  • Keratometric astigmatism Sim K’s Astig -2.9D
  • Specular microscopy

(Noncon Robo SP-8000, Konan Medical inc.,Japan)

Preop.

POD # 1mo.

Sim K’s -2.9D

case 2
Case 2.

Postoperative data at POD # 1month

  • BSCVA 20/40
  • Sperical equivalent +1.00D
  • Keratometric astigmatism Sim K’s Astig -1.8D
  • Specular microscopy

(Noncon Robo SP-8000, Konan Medical inc.,Japan)

preoperative

POD # 2 weeks

case 3 m 40 traumatic corneal scar
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 K’s Astig : -3.2D

first visit

POD 2wks

POD 1mo.

slide9
case 1.

5mo. after operation

Experimental rabbit model

1mo. after operation

  • The experimental model of the operation and UBM finding of the patient’s 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’.
customized modifications of our technique
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 recipient’s 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.
customized modifications of our technique11
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.
conclusion
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
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