No-suture aphakic epikeratoplasty

Use of sutures with aphakic epikeratoplasty is time-consuming during surgery and can create significant hazards for the patient. Thus, a surgical technique for aphakic epikeratoplasty without sutures was developed.

The conventional procedure was modified to use an oversized lenticule tucked evenly in an expanded lamellar pocket with no anchoring sutures. The technique was performed on one eye of 27 consecutive patients over a 9-month period.

After a mean follow up of 14 months, results showed refractive and visual parameters comparable to a sutured technique. A 100% success rate at surgery was obtained using the oversized 9-millimeter lenticule. Five eyes (19.2%) developed a partial lenticule edge dislocation postoperatively. Three of the edge dislocations were reposited at the slit lamp without suturing. One lenticule, manufactured undersize, required primary suturing, leaving 24 of 26 (92.3%) patients healed without sutures. Postoperative spectacle-corrected acuity for the group either improved by one or more Snellen lines or remained unchanged. Two patients had reduced vision: one due to unrelated retinal changes and one due to vernal catarhh resulting in a persistent epithelial defect with subsequent epithelial haze.

A sutureless technique can accomplish visual rehabilitation comparable to the conventional procedure. While the technique is not without complication, significant benefits to the patient include reduced morbidity, eliminating hazards of postoperative suture management, and a simplified surgical procedure.