Suturing techniques and postoperative management in penetrating keratoplasty in the United Kingdom

Abstract

AimsTo report on the suturing techniques and aspects of postoperative management in penetrating keratoplasty in the United Kingdom.MethodsA postal questionnaire was sent to 137 ophthalmic consultants identified from a Royal College of Ophthalmology database as having a special interest in anterior segment surgery. The questionnaire surveyed surgeon preferences for surgical and suturing technique for penetrating keratoplasty surgery, and the postoperative care of corneal grafts.ResultsIn all, 68% of questionnaires were completed and returned: 73% of respondents used a Flieringa ring or equivalent, 94% routinely used cardinal sutures, with 50.5% removing them at the end of the procedure. The most common suturing technique for routine penetrating keratoplasty was a single continuous suture (35%). In these cases, a 10/0 nylon suture was used by 89%. Sixty-six percent changed their technique in high-risk cases, 52% used a 3-1-1 knot, and 75% made a distinction between a reef and granny knot, with 76% using a reef. Thirty percent buried the knots within the donor material, and 29% within the host tissue. Twenty-five percent had no routine time for graft suture removal, but 41% removed them between 1 and 2 years post-surgery. After suture removal, 98% used steroids and 88% used topical antibiotics. Thirty-four percent stopped topical steroids before suture removal, with 38% stopping topical steroids more than 3 months prior to suture removal.ConclusionThis survey demonstrates that there is considerable variation in suturing techniques and postoperative care for penetrating keratoplasty. These significant variations in practice need to be considered when interpreting outcomes and research.

Effect of Surgical Technique on Corneal Implant Performance

“…Two of the most commonly used are radially placed interrupted (individual) sutures and continuous sutures. 5 Generally, continuous sutures are used but in high risk cases, interrupted sutures are considered preferable as a suture break causes less risk for dehiscence and only one suture has to be replaced. A broken continuous suture is more complicated to repair or replace.…”

Management of high-risk corneal transplantation

“…In a Cornea Society survey 66% of respondents reported changing from their usual suturing technique in high risk cases, with changing to an interrupted suture technique in 88% of cases. 90 Regarding suture material, 10–0 monofilament nylon is considered superior to other suture materials. The suture knot is usually rotated into and buried just beneath the corneal surface in the donor stroma, because placing the knot in the host’s stroma may attract vessels.…”

Immunology and Donor-Specific Antibodies in Corneal Transplantation

“…The technique of corneal suturing does not affect the rejection rate, but it is recommended to hide the knot under the surface of the donor's cornea because if it is in the patient's own cornea, it is more likely that irritation will stimulate vascular growth (Maguire et al 1994;Williams et al 2018). It is also recommended for high-risk cases to use interrupted suture technique, as there might be a greater risk of early suture loosening (and a single loose suture can be removed easily without the risk of wound dehiscence) (Lee et al 2012).…”