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Reverse mushroom keratoplasty reliable, efficient grafting method

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Gabriel van Rij, MD, PhD, discussed his technique for reverse mushroom keratoplasty.

OSN Europe/Asia-Pacific Edition Editorial Board Member Gabriel van Rij, MD, PhD, discussed his technique here at a joint session of the French Society of Ophthalmology and European Society of Ophthalmology.

Prof. van Rij said reverse mushroom keratoplasty may be an old technique, but it remains a reliable one because of the self-sealing nature of the graft.

“We find when we put the graft in the eye, the anterior chamber immediately forms around itself,” Dr. van Rij said. “Because of the pressure in the eye, the wound closes itself, which is completely different from a normal graft.”

For the technique, Prof. van Rij places the donor cornea on a Moria artificial anterior chamber, and then makes a trephine cut 0.3 mm deep. His technique involved cutting the outside of the cornea with the trephine, then using a knife to make the inner ring with a cut down to the limbus. The two separate cuts create the reverse mushroom keratoplasty, which is then fit under a cut in the anterior chamber in the recipient eye.

“To remove the donor cornea from the artificial anterior chamber, I put it upside down on a punch block and punch the cornea out. By doing this you get a reverse mushroom,” Prof. van Rij said. He added he makes the larger incision with the trephine and the smaller edge he cuts freehand.

The anterior side of the donor tissue has a diameter of 7.5 mm and the posterior is 9 mm. The recipient cornea is prepared by cutting under the cornea to 9 mm, he said.

“We put the donor cornea in the recipient and immediately the pressure forms from the anterior chamber,” Prof. van Rij said.

He said suturing is very simple because of the pressure exerted by the anterior chamber that holds the graft in place.

“You only need superficial sutures, either interrupted or running sutures, which are what I always use,” he said. “It is not a big deal because the eye closes by itself. You do not need long sutures.”

He added the procedure may sound difficult, but really has a shorter learning curve than surgeons might expect.

“The advantage of the technique is that you end up with very low astigmatism because the tissue cannot go out of the bevel,” Prof. van Rij said. “It is really a very simple technique. Any of you can do it.”