组织黏合剂在改良的显微角膜刀辅助的后板层角膜移植术中的应用

Modified microkeratome-assisted posterior lamellar keratoplasty using a tissue adhesive

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-μ m-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.

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 endotheliurn. 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. d0） 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.