Can we overcome the challenges of sutures in lamellar keratoplasty?

Abstract

Lamellar keratoplasty (LK) is a technique which can be followed for both tectonic and optical purposes. We describe a technique of sutureless anterior LK by fixing the donor lenticule to the recipient bed using fibrin glue. LK was performed in an eye with corneal opacity using the manual dissection method. The donor lenticule was cut with a microkeratome after fixing the corneoscleral rim in an artificial anterior chamber. The size of the donor lenticule was 8.5 mm and fixed to the recipient bed with fibrin glue. The surgical time was reduced significantly with this technique. There was an uneventful postoperative period during the follow-up of 12 months. Best corrected visual acuity improved from hand movement to 20/60. Thus, the use of fibrin glue for fixing the anterior lamellar lenticule is a viable option for both optical and anatomical purposes.

Experimental Application of Tissue Adhesives in Corneal Traumas

“…However, the authors mention that it requires improvement for easier and safer use in ophthalmology. Also, a 2011 case report where lamellar keratoplasty was performed in an eye with corneal opacity by fixing the donor lenticule to the recipient bed with fibrin glue found it to be a time-efficient and effective technique, but requiring further testing (18).…”

“…However, the authors mention that it requires improvement for easier and safer use in ophthalmology. Also, a 2011 case report where lamellar keratoplasty was performed in an eye with corneal opacity by fixing the donor lenticule to the recipient bed with fibrin glue found it to be a time-efficient and effective technique, but requiring further testing (18). A comparable experimental study using fibrin glue, cyanoacrylate glue, and sutures for the closure of clear corneal incisions in porcine eyes supports the use of adhesives, either fibrin or cyanoacrylate, versus sutures, but found a superiority of cyanoacrylate to fibrin adhesive concerning the wound integrity (19).…”

Pediatric corneal transplantation: techniques, challenges, and outcomes

“…Superficial anterior lamellar keratoplasty and automated lamellar therapeutic keratoplasty can be performed for opacities involving the anterior 250 µm and 300 µm, respectively. 65 , 66 Common indications include Reis-Buckler corneal dystrophy, 67 healed keratitis, healed shield ulcer, congenital dermoid and Salzmann nodular degeneration, 68 corneal scarring, and choristoma. 66 Common complications include residual corneal pathology, mild interface haze, recurrence of underlying pathology, dry eye, and epithelial ingrowth.…”