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E. P. Herlihy, R. Shirakawa, B. Iliakis, T. Lindquist, T. T. Shen; Biologic Tissue Adhesive Plus Top-Hat Corneal Button Configuration for Sutureless Penetrating Keratoplasty. Invest. Ophthalmol. Vis. Sci. 2007;48(13):4672.
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To investigate the feasibility and mechanical stability of a top-hat configuration penetrating keratoplasty wound secured with fibrin tissue adhesive (Tisseel) in an eye bank model. The results are compared to a traditional sutured PKP wound.
Intralase and manual dissection techniques were used to create top-hat shaped corneal buttons with anterior diameter 7mm, depth 400 microns, and posterior diameter 9mm. The processed corneoscleral rims were mounted on artificial anterior chambers. The corneal buttons were divided into two groups (A and B). In Group A, the corneal buttons were removed and replaced, secured by interrupted 10-0 nylon sutures. In Group B, the corneal buttons were secured with fibrin tissue adhesive (Tisseel) only. With each specimen mounted on an artificial anterior chamber, IOP (measured by pneumotonometry) was gradually increased. Wound strength was evaluated by determining the IOP level at which wound leakage occurred. Conventional PKP with vertical wound edges, 7mm corneal button diameter, which had been cut from a donor corneoscleral rim using a Hanna trephine, served as a control. The cylindrical button was removed and replaced, secured by interrupted 10-0 nylon sutures.
The mean IOP at which wound leak occurred was 68 mmHg in Group A and 73.5 mmHg in Group B. The mean IOP for the control was 46 mmHg.
Fibrin tissue adhesive, combined with a top-hat corneal button configuration, demonstrates feasibility in the creation of a stable wound construct without sutures in an eye bank model. This implicates the future possibility of in vivo sutureless corneal transplant. Less induced astigmatism, operating time, and infection risk from loose or broken sutures are but a few potential advantages of sutureless penetrating keratoplasty. Further studies, including investigation of the duration of adhesive integrity in human tissue and application methods that are more conducive to ophthalmic use, are necessary.
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