II.2.a Mushroom- / Hat- / Double punch keratoplasty

Mushroom- / Hat- / Double punch keratoplasty

In penetrating keratoplasty, a full-thickness, circular trephination is made in the recipient cornea and a donor button is positioned into the circular opening. As a result, a circular wound is created with a vertical wound edge that introduces two problems. First, the procedure requires sutured fixation of the donor button, not only for the donor to maintain its position, but also to obtain a watertight wound. Second, the forced wound compression attributes to abnormal apposition of the anatomical stromal layers and the anterior as well as the posterior surfaces of the donor and host tissues may not be levelled off.

Although various wound configurations have been described since the 1950s, the NIIOS R&D developed a surgical method to obtain a wound configuration that is potentially self-sealing and levels off by itself. The surgical method was not persued by us, because the techniques for posterior lamellar keratoplasty as described in II.2.b - II.2.e showed more promise.

Since the 1950s, several modifications of the wound edge have been described, for example in:
• The technique for penetrating keratoplasty. In: Barraquer J, Rutllán J (eds): Microsurgery of the cornea. An atlas and textbook. Barcelona, Ediciones scriba, 1984:237-298.

NIIOS Contributions

• Melles GRJ: Experimental, double-punch keratoplasty. Joint Meeting University of Cologne Cologne, Germany, December 1995.
• Melles GRJ, Binder PS: Intrastromally sutured, double-punch keratoplasty. Invest Ophthalmol Vis Sci 1996;37:S944, abstract no 4320.

Parallel developments

• Rowsey JJ. Tampa trephine penetrating keratoplasty: a tissue-tab technique for corneal transplantation. The Tampa Trephine Study Group. Int Ophthalmol Clin 1996;36:141-152.

Spin off

• Busin M. A new lamellar wound configuration for penetrating keratoplasty surgery. Arch Ophthalmol 2003;121:260-265.

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