Modified microkeratome-assisted posterior lamellar keratoplasty using a tissue adhesive

Area of Science:

• Ophthalmology
• Biomaterials Science
• Surgical Innovation

Background:

• Posterior lamellar keratoplasty (PLK) is a surgical technique to restore vision by replacing diseased corneal endothelium.
• Traditional PLK often involves sutures for graft fixation, which can induce astigmatism.
• Microkeratome-assisted techniques offer potential for improved precision in PLK.

Purpose of the Study:

• To compare the efficacy of sutures versus a novel tissue adhesive for graft fixation in an experimental microkeratome-assisted PLK model.
• To evaluate the impact of each fixation method on graft stability and induced astigmatism.

Main Methods:

• Human donor corneoscleral rims underwent a 300-microm partial flap keratectomy using a manual microkeratome.
• A posterior stromal disc was trephined and positioned without sutures, with the flap secured by either 5 interrupted sutures or a chondroitin-sulfate-aldehyde-based adhesive.
• Graft stability was assessed by increasing intrachamber pressures, and astigmatic changes were evaluated using videokeratography.

Main Results:

• The tissue adhesive group exhibited significantly less mean astigmatic change (1.13 D) compared to the sutured group (3.08 D) (P = .008).
• Both the sutured and glued groups demonstrated comparable graft stability, resisting mean pressures of 95.68 mm Hg and 82.45 mm Hg, respectively (P = .97).

Conclusions:

• Microkeratome-assisted PLK with either sutures or tissue adhesive provides excellent graft stability.
• Tissue adhesive fixation resulted in significantly reduced astigmatic changes, offering a potential advantage over sutures.
• Sutureless PLK using tissue adhesive represents a viable alternative for treating corneal endothelial disorders.