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Outcomes of femtosecond-assisted mushroom keratoplasty

Poster Details

First Author: S.Madi EGYPT

Co Author(s):    J. Beltz   M. El-Anwar                 

Abstract Details


To report the visual outcomes and graft survival of mushroom shaped keratoplasty using femtosecond laser for the treatment of full thickness cornea opacities and healthy endothelium.


Icare hospital affiliated with Alexandria university


Retrospective chart review of 23 eyes of 23 patients (herpetic scar, n=10; keratoconus, n=7; bacterial scar, n= 3; traumatic scar, n=2 and failed graft, n=1) undergoing femtosecond-assisted mushroom shaped keratoplasty at Icare private hospital using the wavelight FS200 laser platform. The mushroom shaped graft consisted of a large top hat (9 mm in diameter and 230 microns in thickness) and a small stalk (6-6.5 mm). The donor was oversized by 0.2 mm. Outcome measures were best spectacle-corrected visual acuity (BSCVA), refraction, corneal topography, endothelial cell density, graft rejection, and graft failure at 1,3,6 and 12 months.


Average follow-up was 9 months (range 6�â�€�“15). All grafts were clear at the last follow up visit. Excluding eyes with pre-existing ocular co-morbidities, the percentage of patients achieving BSCVA of 20/40 or better at 1,3,6 and 12 months was 66.7%, 90.5%, 95.2% and 100%, respectively. At last follow up, the refractive cylinder was less than 6 Diopters (D) all eyes (mean=3.7 D). Mean endothelial cell loss at 3,6 and 12 months was 18.8%, 20.1% and 21.1%, respectively. Complications included 6 cases (26.1%) with incomplete cut requiring manual hand refinement and 2 endothelial rejections (8.7%) that resolved with topical steroids.


Femtosecond-assisted mushroom keratoplasty shows faster visual recovery, better visual acuity and limited postoperative astigmatism with no increase risk of rejection when compared to conventional penetrating keratoplasty .

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