Tissue glue allows sutureless posterior lamellar keratoplasty in lab study

A sutureless posterior lamellar keratoplasty technique using tissue adhesive may be an alternative for surgical treatment of corneal endothelial disorders, a study in eye bank eyes suggests.

Ashkan Pirouzmanesh, MD, and colleagues at Wilmer Eye Institute in Baltimore compared graft stability and astigmatic changes using sutures or tissue adhesive in an experimental model of microkeratome-assisted posterior lamellar keratoplasty. The modified technique for posterior lamellar keratoplasty used in the study employed a manual microkeratome and an artificial anterior chamber.

A “novel chondroitin-sulfate-based corneal adhesive” was compared with five interrupted sutures for flap fixation, the researchers said. Each technique was used in four human donor corneas.

A manual Moria LSK microkeratome was used to perform a partial thickness keratectomy with a large hinge. A fresh blade was used for each procedure. Corneas were centered on a Moria ALTK artificial anterior chamber.

Donor discs were placed, and in one group of eyes, the flap was secured with five interrupted 10-0 nylon sutures. In the group, the flap was secured using the tissue adhesive. The transplanted discs were not glued or sutured in either group, but were kept in place by surface tension.

The surgical procedure was “simple and similar to a combination of a corneal flap technique and penetrating keratoplasty,” Dr. Pirouzmanesh and colleagues said. The mean change in average keratometry values was 3.08 D in the sutured group and 1.13 D in the non-sutured group. Both groups had excellent graft stability, the study authors said.

The study is published in the February issue of Archives of Ophthalmology.