Technique to minimize asymmetric suture placement during penetrating keratoplasty

Surgeons must mark the donor and recipient tissues precisely during penetrating keratoplasty, and verify the correct position of these marks in the actual donor button and trephine sites to minimize asymmetric placement of the graft within the host wound.

A unique surgical reticule has been developed that simplifies proper marking of both the donor and recipient tissues with gentian violet. The reticule is placed within the oculars of the operating microscope. The circumference of the donor tissue and partial-thickness trephined host wound are aligned with a 5 mm inscribed circle. Eight equidistant lines, separated by 45 degrees around the circle, are used to place marks on the donor tissue and confirm the correct peripheral placement of limbal lines on the host tissue. The surgeon uses these landmarks for cardinal suture placement.

The reticule is easy to use with any size of trephine, and does not interfere with other surgical maneuvers during surgery.

Correct suturing of the first eight cardinal sutures can occur only if the donor button is marked after it has been prepared, and the location of the recipient marks are verified after the actual trephination impression has been made. This reticule should minimize the role of asymmetric suturing on final graft astigmatism.