Penetrating keratoplasty: the search for a sutureless solution
Al Bahrani, Faisal
MetadataShow full item record
SPECIFIC AIM: Worldwide, there is a deficiency in the availability and the outcomes of corneal transplants procedures. The use of sutures in the various types of corneal transplant procedures increases the skill requirements for performing the procedure in addition to bringing about various suture-related complications. In order to avoid these complications and to make the procedure easier to perform, it is vital to review the properties and availability of various surgical adhesives in order to assess their potential as candidates for replacing suture use in corneal transplant procedures. The focus in this paper will be on the most prominent of these procedures: the penetrating keratoplasty procedure. RECENT FINDINGS: Surgical adhesives that could potentially act as replacements or adjuncts to suture use in the penetrating keratoplasty procedure include homologous fibrin adhesives, polyethylene glycol sealants, cyanoacrylate glue, and poly [glycerol-sebacate-acrylate] (PGSA) glue. Polyethylene glycol sealants, when used as adjuncts to suture use in keratoplasty procedures lead to significant levels of wound dehiscence. Fibrin glues have been found to reduce the amount of sutures required in a "top hat" wound configuration penetrating keratoplasty when used as an adjunct to sutures in binding the donor button in place. Cyanoacrylate glues, although having higher levels of adhesive strength than fibrin glue, lead to various unwanted side effects. Lastly, PGSA glue, given its recent development, remains an uncertainty due to the lack of research on it. SUMMARY: Overall, use of homologous fibrin glues is currently the most likely way to reduce the use of sutures in the penetrating keratoplasty procedure. Its use could lead to shorter operative times, fewer complications, reductions in cost, and higher availability for corneal transplant procedures. However, with further investigation, PGSA glue may prove to be a better candidate for the replacement of sutures than fibrin glues.