Endokeratoplasty without graft suture: Preliminary results

Abstract

Abstract: : Purpose: To evaluate the medium and long–term viability of sutureless endokeratoplasty graft (EKP), a new surgical procedure for treatment of corneal endothelial decompensation. Methods: Seven patients with Fuchs’ corneal dystrophy (n = 4) and pseudophakic bullous keratopathy (n = 3) underwent EKP. For six patients the surgical procedure included the creation of a 9.0 mm (diameter) and 160 µm (thickness) corneal flap, substitution of an underlying 7.0 mm button of deep stroma and endothelium with a 7.25 mm donor button, and suturing of the flap back into position using a 10–0 running nylon suture. In one patient, a free corneal flap required the change of the EKP to penetrating keratoplasty. Donor cornea was held with an artificial anterior chamber and the lenticule was excised using a microkeratome, placed endothelial side up and, using a trephine, a donor stromal button was punched. Results:In three cases an anterior chamber leakage was observed and the underlying button needed to be replaced the second day post–op. Two of them showed a corneal flap edema that resolved after seven days in one patient and after six weeks in the second case. In five cases the cornea was clear four weeks after surgery. In all patients the sutures were safely removed by the end of the fourth postoperative month. The best mean corrected visual acuity significantly improved after a mean follow up of 11 ± 10.8 months. Conclusions: Endokeratoplasty without graft suture is a promising new procedure for patients with corneal endothelium dysfunction. Our initial encouraging results must be confirmed in much larger population followed over a period of several years. The early removal of the sutures, the fast healing course and the less risk of rejection due to deep location of the donor button, represent the main advantages of this technique, if compared with the conventional penetrating keratoplasty.

Keywords: cornea: endothelium • cornea: clinical science