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A. Pirouzmanesh, S. Herretes, J.M. G. Reyes, O. Suwan–Apichon, R.S. Chuck, D.–A. Wang, J.H. Elisseeff, W.J. Stark, A. Behrens; Modified Microkeratome–Assisted Posterior Lamellar Keratoplasty Using a Tissue Adhesive as Sealant . Invest. Ophthalmol. Vis. Sci. 2005;46(13):2713.
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© ARVO (1962-2015); The Authors (2016-present)
Purpose: To compare graft stability and astigmatic change using suture vs. tissue adhesive in an experimental model of microkeratome–assisted posterior lamellar keratoplasty (PLK). Methods: A 300–µm thick partial flap–keratectomy was performed in human donor corneoscleral rims using an artificial anterior chamber and a manual microkeratome. The flap stopped at the left central opening border, providing a wide hinge to add stability. After flap reflection, a 6.25 mm trephination was performed obtaining a disc of posterior stroma, Descemet’s membrane, and endothelium. The disc was positioned in a sutureless fashion, and the flap secured with either 5 interrupted sutures, or a chondroitin–sulfate–aldehyde based adhesive. Increasing intrachamber pressures were created detecting graft stability. Videokeratographic data was recorded evaluating astigmatic change. Results: The mean astigmatic change was 3.08 D (0.84) in the sutured group, and 1.13 D (0.55) in the glued group (p=0.008). Mean resisted pressures were 95.68 (27.38) mmHg and 82.45 (18.40) mmHg in the sutured and glued groups, respectively (p=0.97). Conclusions: This modified technique of microkeratome–assisted PLK showed excellent graft stability in both groups. Flaps sealed with the novel tissue adhesive had reduced astigmatic changes in our experimental model.
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