Transcript Mushroom shaped wound configurized penetrating keratoplasty

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
• 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
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
Indication and Basic operation
method
healthy recipient’s peripheral endothelium with large
stromal disease
Prepared
Donor cornea
Stepwise
Trephinized
Recipient
Cornea
Patients and Methods
3 cases with full thickness corneal disease
M/36
M/27
M/40
corneal laceration,
traumatic cataract
Keratoconus with healed
corneal hydrops
corneal scar after
lacerated wounding
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)
postopertive 1yr.
Preop.
CD
CV
6A
1400
37
57
POD # 1mo.
Sim K’s -2.9D
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)
postopertive 1mo.
preoperative
CD
CV
6A
2077
43
40
POD # 2 weeks
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.
Experimental rabbit model
1mo. after operation
case 1.
5mo. 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
• 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, mushroomshaped 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 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
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