{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,13]],"date-time":"2026-06-13T05:04:35Z","timestamp":1781327075764,"version":"3.54.1"},"reference-count":64,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2025,1,8]],"date-time":"2025-01-08T00:00:00Z","timestamp":1736294400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100015550","name":"Ministero della Salute (Italian Ministry of Health)","doi-asserted-by":"publisher","award":["2023-2780760"],"award-info":[{"award-number":["2023-2780760"]}],"id":[{"id":"10.13039\/501100015550","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Fondazione Italia","award":["2023-2780760"],"award-info":[{"award-number":["2023-2780760"]}]},{"name":"Italian Ministry oh Health","award":["2023-2780760"],"award-info":[{"award-number":["2023-2780760"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Objective: The aim of this study was to evaluate the effect of a surgical technique for managing post-penetrating keratoplasty (PK) ectasia complicated by late endothelial failure (LEF). Methods: A single-center pilot case series was conducted regarding consecutive patients affected by post-PK ectasia with late graft failure. Using a microkeratome, a single donor cornea was dissected to prepare a two-piece graft, comprising a larger anterior lamella made up of anterior stroma and a smaller posterior lamella made up of posterior stroma, Descemet\u2019s membrane, and endothelium. The two lamellae were then positioned on the appropriately prepared recipient cornea. The technique was applied to 15 patients between 2022 and 2023, and data were retrospectively collected from preoperative evaluations and at 1, 6, and 12 months, post-operatively. At each visit, patients underwent standard clinical evaluation, corneal topography, and endothelial cell density evaluation, and visual acuity was measured using a LogMAR chart. Results: The technique restored normal corneal curvature and achieved a clear graft in all patients, leading to the resolution of preoperative ectasia and improved corneal pachymetry. At the one-year follow-up, the average K was reduced from 51.1 \u00b1 4.5 D to 43.5 \u00b1 1.1 D; the best corrected visual acuity (BCVA) was improved from 1.1 \u00b1 0.4 to 0.3 \u00b1 0.2 LogMAR; the central corneal thickness was reduced from 629 \u00b1 39 \u03bcm to 532 \u00b1 45 \u00b5m; and the endothelial cell density was 1926 \u00b1 199 cells\/mm2. None of the patients developed severe complications. Conclusions: The two-piece manual mushroom PK may represent an effective technique for managing complex post-PK ectasia cases combined with endothelial decompensation.<\/jats:p>","DOI":"10.3390\/jcm14020343","type":"journal-article","created":{"date-parts":[[2025,1,8]],"date-time":"2025-01-08T07:40:13Z","timestamp":1736322013000},"page":"343","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["A Pilot Case Series on the Use of a Large Mushroom-Shaped Corneal Graft for the Surgical Management of Post-Penetrating Keratoplasty Ectasia and Endothelial Failure"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2847-1691","authenticated-orcid":false,"given":"Antonio","family":"Moramarco","sequence":"first","affiliation":[{"name":"IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40126 Bologna, Italy"},{"name":"Ophthalmology Unit, Dipartimento di Scienze Mediche e Chirurgiche, Alma Mater Studiorum University of Bologna, Via Palagi 9, 40138 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3877-0417","authenticated-orcid":false,"given":"Luigi","family":"Fontana","sequence":"additional","affiliation":[{"name":"IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40126 Bologna, Italy"},{"name":"Ophthalmology Unit, Dipartimento di Scienze Mediche e Chirurgiche, Alma Mater Studiorum University of Bologna, Via Palagi 9, 40138 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9359-8608","authenticated-orcid":false,"given":"Natalie","family":"di Geronimo","sequence":"additional","affiliation":[{"name":"IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40126 Bologna, Italy"},{"name":"Ophthalmology Unit, Dipartimento di Scienze Mediche e Chirurgiche, Alma Mater Studiorum University of Bologna, Via Palagi 9, 40138 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giulio","family":"Rapezzi","sequence":"additional","affiliation":[{"name":"IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40126 Bologna, Italy"},{"name":"Ophthalmology Unit, Dipartimento di Scienze Mediche e Chirurgiche, Alma Mater Studiorum University of Bologna, Via Palagi 9, 40138 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giacomo","family":"Savini","sequence":"additional","affiliation":[{"name":"IRCCS Bietti Foundation, 00198 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8274-2662","authenticated-orcid":false,"given":"Pietro","family":"Viola","sequence":"additional","affiliation":[{"name":"Ophthalmology Unit, San Bortolo Hospital, 36100 Vicenza, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2442-4081","authenticated-orcid":false,"given":"Maurizio","family":"Mete","sequence":"additional","affiliation":[{"name":"IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40126 Bologna, Italy"},{"name":"Ophthalmology Unit, Dipartimento di Scienze Mediche e Chirurgiche, Alma Mater Studiorum University of Bologna, Via Palagi 9, 40138 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5148-7643","authenticated-orcid":false,"given":"Vito","family":"Romano","sequence":"additional","affiliation":[{"name":"Eye Unit, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, 25123 Brescia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,1,8]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Moramarco, A., Gardini, L., Iannetta, D., Versura, P., and Fontana, L. 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