Cornea. 2026 Jun 3. doi: 10.1097/ICO.0000000000004080. Online ahead of print.
ABSTRACT
PURPOSE: The aim of this study was to compare the outcomes of 2-piece mushroom keratoplasty (MK) between eyes at high risk and eyes at low risk of immunologic rejection.
METHODS: This is a retrospective interventional case series including 475 eyes from 475 patients who underwent 2-piece MK, of whom 146 (30.7%) were classified as high risk of rejection (group 1) and 329 (69.3%) as low risk (group 2). Outcome measures included corrected distance visual acuity, endothelial cell count, endothelial cell loss, graft survival rate, and postoperative complications.
RESULTS: There was no significant difference in endothelial cell count between groups at 10 years after transplantation (754.7 ± 316.7 [95% CI: 695.1-956.6] vs. 892.3 ± 298.8 [95% CI: 757.8-969.4] cells/mm2, P = 0.088, respectively). Although corrected distance visual acuity was better in the low-risk group at 1 year (0.37 ± 0.30 [95% CI: 0.32-0.42] vs. 0.25 ± 0.23 [95% CI: 0.23-0.28], P < 0.001) and 5 years (0.20 ± 0.26 [95% CI: 0.15-0.27] vs. 0.14 ± 0.21 [95% CI: 0.10-0.17], P = 0.044), this difference was no longer statistically significant at 10 years (0.25 ± 0.34 [95% CI: 0.13-0.39] vs. 0.18 ± 0.25 [95% CI: 0.12-0.24] logMAR, P = 0.269, respectively). Postoperative complication rates were comparable, except for infections, which occurred more frequently in group 1 (7.5% vs. 1.5%, P < 0.001). Graft survival rates at 10 years were 80.3% for group 1 (n = 24) and 90.7% for group 2 (n = 50) (P = 0.153).
CONCLUSIONS: Two-piece MK provides consistent long-term outcomes in both high-risk and low-risk eyes, showing comparable visual, endothelial, and survival results. These findings highlight the potential of MK to reduce the impact of preoperative immunologic risk and expand its role in complex corneal transplantation.
PMID:42284083 | DOI:10.1097/ICO.0000000000004080
