1. Mushroom shaped wound configurized penetrating keratoplasty and its customized modifications Hong Kyun Kim 1, Sang Hee Lee 2, Won Mun Seo 1. Sun Hwa Chai 1 Dept. of Ophthalmology Kyungpook natl.univ. school of medicine 1 Metro Eye Center 2

2. Classic, vertical edge-to-edge wound requires relatively tight sutures to withstand the effect of intraocular pressure and it takes too long to achieve complete wound. High incidence of induced astigmatism The risk of wound dehiscence high rate of graft rejection The Shortcomings of conventional PKP

3. Purpose In order to overcome the shortcomings of conventional penetrating keratoplasty, We designed the mushroom shaped wound configurized keratoplsty and performed in the 3 eyes This study is aimed to describe our new keratoplasty technique and its customized modifications for the conditions of recipient’s cornea.

4. Mushroom shaped penetrating Keratoplasty Indication and Basic operation method healthy recipient’s peripheral endothelium with large stromal disease Prepared Donor cornea Stepwise Trephinized Recipient Cornea

5. Patients and Methods 3 cases with full thickness corneal disease M/36 corneal laceration, traumatic cataract M/27 Keratoconus with healed corneal hydrops M/40 corneal scar after lacerated wounding

6. Case 1. M/36 traumatic corneal scar Postoperative data -BSCVA 20/32 -Sperical equivalent +0.50D -Keratometric astigmatism Sim K’s Astig -2.9D -Specular microscopy (Noncon Robo SP-8000, Konan Medical inc.,Japan) CDCV6A postopertive 1yr.14003757 Preop.POD # 1mo. Sim K’s -2.9D

7. Case 2. Postoperative data at POD # 1month -BSCVA 20/40 -Sperical equivalent +1.00D -Keratometric astigmatism Sim K’s Astig -1.8D -Specular microscopy (Noncon Robo SP-8000, Konan Medical inc.,Japan) CDCV6A postopertive 1mo.20774340 preoperativePOD # 2 weeks

8. Case 3. M/40 traumatic corneal scar Preoperative data -BCVA : 20/1000 -Sperical equivalent uncheckable -Keratometric astigmatism uncheckable Postoperative Results at POD 6mo. -BCVA : 20/80 -Sim K’s Astig : -3.2D first visitPOD 2wksPOD 1mo.

9. case 1. 5mo. after operation Experimental rabbit model 1mo. after operation The experimental model of the operation and UBM finding of the patient’s postoperative photo showed stable wound configuration. The tight wound configuration resembles a ‘butterfly clamp’ that traditionally used in the Korean wooden archtecture. We named our technique as ‘Butterfly clamp shaped keratoplasty’.

10. Customized Modifications of Our Technique It can also be applied the proto-type Butterfly-clamp shaped kratoplasty and customized the anterior or posterior diameter of the donor cornea according to the recipient’s corneal status: We performed Gonio-saving mushroom-shaped procedure for two cases of the anterior segment dysgenesis patients, mushroom-shaped anterior lamellar keratoplasty for an advanced keratoconus, mushroom shaped corneolimbal allograft for a limbal deficiency. The results of the modifications are closely being monitored. Gonio-saving mushroom-shaped procedure has a advantage that it does not touch the peripheral synechial sturcture. It can avoid the possible complications, such as postoperative hyphema, iris incarceration into wound, peripheral anterior synechiae.

11. Customized Modifications of Our Technique mushroom ALKP It can reduce postoperative steepening such an advanced keratoconic patient. mushroom shaped corneolimbal allograft We can easily performed the corneolimbal allograft in the total limbal deficiency with the only one donor cornea.

12. Conclusion Advantage of Mushroom Shaped Wound Configurized Keratoplasty more stable surgical wound fast recovery less irregular astigmatism lower donor tissue volume Disadvantage need additional machine and device it is not familiar to surgeon