Manual Trephination of Mushroom Keratoplasty in Advanced Keratoconus

PURPOSE:To evaluate the technique of mushroom keratoplasty for patients with advanced keratoconus, with respect to postoperative astigmatism, visual improvement and stability, and endothelial cell count. METHODS:Sixteen eyes of 15 patients with advanced keratoconus received a mushroom keratoplasty at the Erasmus Medical Centre at Rotterdam between April 2003 and May 2006. The donor cornea had a larger anterior stromal lamella (9.0 mm) and a smaller posterior part (7.0 mm). Visual acuity and keratometry were measured at 6, 12, 24, and 36 months. Specular microscopy was performed annually. RESULTS:Best-corrected visual acuity improved significantly (P = 0.003) from 0.25 ± 0.20 preoperatively to 0.62 ± 0.22 at 6 months postoperatively. Visual acuity remained stable with a best-corrected visual acuity of 0.70 ± 0.22 from 1 year onward. At all follow-up periods, mean postoperative astigmatism remained