Pirouzmanesh Ashkan, Herretes Samantha, Reyes Johann M G, Suwan-apichon Olan, Chuck Roy S, Wang Dong-An, Elisseeff Jennifer H, Stark Walter J, Behrens Ashley
Wilmer Ophthalmological Institute, Johns Hopkins University, Baltimore, MD 21287-9278, USA.
Arch Ophthalmol. 2006 Feb;124(2):210-4. doi: 10.1001/archopht.124.2.210.
To compare graft stability and astigmatic change using suture vs tissue adhesive in an experimental model of microkeratome-assisted posterior lamellar keratoplasty.
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.
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).
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.
Sutureless microkeratome-assisted posterior lamellar keratoplasty using tissue adhesive may become a new alternative in the surgical treatment of corneal endothelial disorders.
在微型角膜刀辅助后板层角膜移植术的实验模型中，比较使用缝线与组织粘合剂时植片的稳定性和散光变化。
使用人工前房和手动微型角膜刀在人类供体角膜缘进行300微米厚的部分瓣状角膜切除术。瓣在左侧中央开口边界处停止，提供一个宽铰链以增加稳定性。瓣翻转后，进行6.25毫米的环钻以获取后基质、Descemet膜和内皮的圆盘。将圆盘以无缝线方式定位，并用5根间断缝线或基于硫酸软骨素醛的粘合剂固定瓣。增加前房内压力以检测植片稳定性。记录角膜地形图数据以评估散光变化。
缝合组平均（标准差）散光变化为3.08（0.84）屈光度（D），粘合组为1.13（0.55）D（P = 0.008）。缝合组和粘合组的平均（标准差）抵抗压力分别为95.68（27.38）毫米汞柱和82.45（18.40）毫米汞柱（P = 0.97）。
这种改良的微型角膜刀辅助后板层角膜移植术在两组中均显示出优异的植片稳定性。在我们的实验模型中，用新型组织粘合剂密封的瓣散光变化减少。
使用组织粘合剂的无缝线微型角膜刀辅助后板层角膜移植术可能成为角膜内皮疾病手术治疗的一种新选择。
