Posterior mushroom keratoplasty in patients with Fuchs endothelial dystrophy and pseudophakic butlous keratopathy - Transplant outcome

Purpose: To report the outcome of posterior mushroom or top-hat-shaped keratoplasty for patients with Fuchs endothelial dystrophy (FED) or pseudophakic bullous keratopathy (PBK), concerning postoperative astigmatism, visual improvement, and endothelial cell density. Methods: Twenty-two eyes of 21 patients who received a posterior mushroom keratoplasty for FED (n = 19) or PBK (n = 3) between March 2003 and January 2006 at the Erasmus MC, Rotterdam, The Netherlands, were included. Visual acuity, refraction, and keratometry were measured at 6, 12, 24, and 36 months. Specular microscopy was performed annually. Results: Best-corrected visual acuity (BCVA) significantly (P < 0.05) improved from 0.25 preoperatively to 0.47 at 6 months and 0.64 at I year postoperatively. Visual acuity remained stable with a BCVA of 0.62 2 years and 0.69 3 years after keratoplasty. At the last follow-up, the BCVA measured 0.5 or more in all but 2 (91%) eyes. Mean postoperative astigmatism at 1, 2, and 3 years measured 2.72 +/- 1.48, 2.69 +/- 1.85, and 1.75 +/- 1.76 D. Endothelial cell density averaged 2143 428 cells/mm(2) at 1 year, 1539 +/- 573 cells/mm(2) at 2 years, and 1920 +/- 474 cells/mm(2) at 3 years. All studied transplants remained functional and clear throughout the follow-up period. Conclusions: The posterior mushroom keratoplasty in FED and PBK results in a relatively good visual acuity, low astigmatism, and good endothelial cell density. The short-term results of our limited series of patients are encouraging.