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Deep Suturing Technique for Penetrating Keratoplasty

Busin, Massimo M.D.; Arffa, Robert C. M.D.

Clinical Sciences

Purpose. To evaluate the effect of a new suturing technique on postkeratoplasty visual rehabilitation time and refractive error.

Methods. Penetrating keratoplasty was performed on 17 eyes with keratoconus using a modified suturing technique. A donor button 8.0 mm in diameter was sutured into a 7.75-mm recipient bed with both deep and superficial sutures. The deep sutures consisted of either a single 16-bite 10-0 nylon running suture (n = 7) or eight interrupted 10-0 nylon cross-stitches (n = 10). These sutures were passed into the mid-stroma of the donor cornea and exited through the donor endothelium, then passed through the endothelium of the recipient cornea and exited from its mid-stroma. Thereby all parts of the deep sutures remained below the corneal surface. To further secure the surgical wound, in each case a running 16-bite 10-0 nylon superficial suture was also placed. Care was taken to maintain the bites of the superficial suture above the level of the deep sutures. The superficial suture was removed 3 months after surgery. Vision and refraction were recorded 1 day and 1 month postoperatively and 1 and 3 months after suture removal. A paired Student t test was used to verify the significance of changes in visual acuity and refraction recorded at different examination times.

Results. As early as 1 month after surgery, spectacle best-corrected visual acuity 20/40 or more and refractive astigmatism less than 4 diopters (D) were recorded in each eye and maintained with two exceptions at the later examination times. In two patients, postoperative astigmatism increased from 4.5 to 5 D after suture removal.

Conclusions. Deep suturing allowed quick visual rehabilitation while minimizing postkeratoplasty astigmatism in the patients with keratoconus operated on in this series.

From Ospedale S. Carlo-IDI, Rome, and Casa di Cura “Villa Serena,” Forlì (M.B.), Italy; University of Pittsburgh School of Medicine (R.C.A.), Pittsburgh, Pennsylvania, U.S.A.

Submitted February 5, 2002.

Revision received June 7, 2002.

Accepted June 10, 2002.

None of the authors has any proprietary or financial interest in any instrument discussed in this paper.

Presented in part at the annual Castroviejo Society meeting, Dallas, Texas, October 2000.

Address correspondence and reprint requests to Massimo Busin, M.D., Via Sisa 33, 47100 Forli, Italy. E-mail:

© 2002 Lippincott Williams & Wilkins, Inc.