Modified microkeratome-assisted posterior lamellar keratoplasty using a tissue adhesive

Arch Ophthalmol. 2006 Feb;124(2):210-4. doi: 10.1001/archopht.124.2.210.


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-microm-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.

Publication types

  • Comparative Study
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Astigmatism / prevention & control
  • Corneal Diseases / surgery
  • Corneal Topography
  • Corneal Transplantation / methods*
  • Endothelium, Corneal / drug effects
  • Endothelium, Corneal / surgery
  • Female
  • Graft Survival / physiology
  • Humans
  • Intraocular Pressure
  • Male
  • Middle Aged
  • Surgical Flaps
  • Surgical Wound Dehiscence / prevention & control
  • Suture Techniques
  • Tissue Adhesives / therapeutic use*
  • Tissue Donors
  • Wound Healing / drug effects


  • Tissue Adhesives