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I. Bahar, I. Kaiserman, P. McAllum, A. Slomovic, D. Rootman; Fibrin Glue for Opposing Wound Edges in "Top Hat" Penetrating Keratoplasty: A Laboratory Study. Invest. Ophthalmol. Vis. Sci. 2007;48(13):4670.
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© ARVO (1962-2015); The Authors (2016-present)
To evaluate the advantages of fibrin glue for opposing wound edges during top hat Penetrating Keratoplasty (PK).
Eighteen human corneoscleral rims were mounted on an artificial anterior chamber. Eight samples (group I) were assigned to the traditional PK group. Five samples (group II) underwent top hat PK (outer diameter 9.0 mm, inner diameter 7.0 mm) and 5 underwent top hat PK , using fibrin glue for opposing wound edges. Mechanical stability was evaluated after placement of 8 and 16 interrupted sutures .Main outcome measures : wound bursting pressure, induced astigmatism.
In the traditional PK group , wound bursting pressure was 25. 2 ± 6.3 mm Hg and at 59.1 ± 11.9 mm Hg after placement of 8 and 16 sutures respectively. In the "top hat" PK, leakage occurred at 57.6 ± 4.4 mm Hg and 103.8 ± 18.2 mm Hg after placement of the 8 and 16 interrupted sutures, respectively. In the "top hat" PK + fibrin glue group wound leakage occurred at 144.6 ± 16.5 mm Hg after placement of the 8 sutures and at > 158 mm Hg after placement of 16 sutures. The "top hat" PK + fibrin glue group (8 sutures) induced astigmatism of 1.7 ± 0.6 D, whereas the traditional PK group and the "top hat" PK group (16 sutures) showed an induced astigmatism of 3.1 ± 1.8 D and 3.1 ± 1.3 D, respectively (p=0.011).
The use of fibrin glue in "top hat" PK was found to be more mechanically stable than traditional sutures. This technique facilitated the surgical procedure and enabled less suturing and thus less induced astigmatism. Wound closure with the adhesive may reduce the number of sutures required in corneal transplantation and decrease the incidence of suture-related complications and allograft rejection.
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