Two-Piece Mushroom Keratoplasty For The Treatment Of Congenital Corneal Opacities
Published 2025 - 43rd Congress of the ESCRS
Reference: PO124 | Type: Case Report | DOI: 10.82333/x2hd-0y25
Authors: Elena Franco* 1 , Angeli Christy Yu 2 , Marco Mura 3 , Massimo Busin 2
1Department of Translational Medicine,University of Ferrara,Ferrara,Italy;Department of Ophthalmology,Sant'Anna University Hospital,Ferrara,Italy, 2Department of Translational Medicine,University of Ferrara,Ferrara,Italy;Department of Ophthalmology,Ospedali Privati Forlì "Villa Igea",Forlì,Italy;Istituto Internazionale per la Ricerca e Formazione in Oftalmologia,Forlì,Italy, 3Department of Translational Medicine,University of Ferrara,Ferrara,Italy;Department of Ophthalmology,Sant'Anna University Hospital,Ferrara,Italy;Department of Ophthalmology,King Khaled Eye Specialist Hospital,Riyadh,Saudi Arabia
Purpose
To describe a modified two-piece mushroom keratoplasty technique for the treatment of congenital corneal opacity (CCO) in an infant.
Setting
Ophthalmology Unit of Sant’Anna Hospital (Ferrara)- Ospedali Privati Forlì (Forlì).
Report of case
A 4-month-old male was referred to our institution for right CCO. On examination under anesthesia, there was a vascularized opacity involving the visual axis, with iridocorneal adhesions but no keratolenticular adhesions. The child was treated with a modified two-piece mushroom keratoplasty.
The recipient cornea was trephined 8.00 mm in diameter and 200 microns in depth. The anterior lamella was removed by manual dissection. A two-piece donor graft consisting of a large anterior stromal lamella (8.25 mm in diameter and 250 μm in thickness) and a small posterior lamella (6.00 mm in diameter) including deep stroma and endothelium, was prepared with the aid of a microkeratome. A 6-mm biopsy punch was used to mark centrally the residual recipient bed, and 4 full-thickness incisions were made. To avoid an open-sky surgery, the anterior donor lamella was sutured into position with 4 cardinal sutures. Subsequently, synechiolysis and central button excision were completed with corneal scissors. The donor stem was inserted into the anterior chamber using a pull-through technique and was fitted into the central hole without sutures. The anterior lamella was further sutured with 12 10/0 Nylon sutures. Finally, the anterior chamber was filled with balanced salt solution. Topical tobramycin and dexamethasone were used 6 times per day and gradually tapered to once daily. All the sutures were removed within 3 months; 18 months after surgery the cornea was clear, and no rejection occurred.
Conclusion/Take home message
The modified two-piece mushroom keratoplasty is a viable surgical option for treating congenital corneal opacities. The removal of the host deep corneal button only when the anterior donor lamella is sutured into position offers the advantage of a closed-sky surgery, which is very important considering the high intraoperative vitreous pressure and the low scleral rigidity of pediatric eyes.
The small donor stem correlates with a lower antigenic load, thus reducing the risk of rejection.
Finally, this type of keratoplasty provides a stronger wound profile, reducing the risk of wound dehiscence.