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Ashkan Pirouzmanesh, MD; Samantha Herretes, MD; Johann M. G. Reyes, MD; Olan Suwan-apichon, MD; Roy S. Chuck, MD, PhD; Dong-An Wang, PhD; Jennifer H. Elisseeff, PhD; Walter J. Stark, MD; Ashley Behrens, MD

Arch Ophthalmol. 2006;124:210-214.

Objective  To compare graft stability and astigmatic change using suture vs tissue adhesive in an experimental model of microkeratome-assisted posterior lamellar keratoplasty.

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 to obtain a disc of posterior stroma, Descemet 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 to detect graft stability. Videokeratographic data were recorded to evaluate astigmatic change.

Results  The mean (SD) astigmatic change was 3.08 (0.84) diopters (D) in the sutured group and 1.13 (0.55) D in the glued group (P = .008). Mean (SD) resisted pressures were 95.68 (27.38) mm Hg and 82.45 (18.40) mm Hg in the sutured and glued groups, respectively (P = .97).

Conclusion  This modified technique of microkeratome-assisted posterior lamellar keratoplasty showed excellent graft stability in both groups. Flaps sealed with the novel tissue adhesive had reduced astigmatic changes in our experimental model.

Clinical Relevance  Sutureless microkeratome-assisted posterior lamellar keratoplasty using tissue adhesive may become a new alternative in the surgical treatment of corneal endothelial disorders.

Author Affiliations: Wilmer Ophthalmological Institute (Drs Pirouzmanesh, Herretes, Reyes, Suwan-apichon, Chuck, Stark, and Behrens) and Departments of Cell Biology and Biomedical Engineering (Drs Wang and Elisseeff), Johns Hopkins University, Baltimore, Md.

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