Mushroom Penetrating Keratoplasty: A Narrative Review

While full-thickness penetrating keratoplasty (PK) has seen a decline in favor of partial-thickness techniques like endothelial keratoplasty (EK) and anterior lamellar keratoplasty (ALK), PK remains indicated for corneal disease involving the entire corneal thickness. Mushroom keratoplasty (MK) is a noteworthy modification of PK, designed to combine the refractive benefits of a large-diameter anterior lamellar graft with the graft survival advantage of limited replacement of the corneal endothelium. Leveraging the use of a microkeratome, the MK donor graft can be prepared by microkeratome dissection, thereby achieving a central interface compatible with 20/20 Snellen vision. This review explores the various surgical techniques, visual outcomes, graft survival rates, and complication rates associated with MK for various indications.