No sutures corneal grafting—A novel use of overlay sutures and fibrin glue in Deep Anterior Lamellar Keratoplasty

Abstract 

Purpose

To describe a case where Deep Anterior Lamellar Keratoplasty (DLK) was performed using overlay sutures and fibrin glue alone, without the need to directly suture the corneal button.

Methods

Deep Anterior Lamellar Keratoplasty was performed using a modified Melles technique on a 21-year-old patient who had stromal scarring secondary to severe infective keratitis. Overlay sutures and fibrin glue were used to secure the donor button and then a bandage contact lens was inserted. No sutures were required to directly suture the donor button to host tissue. All securing sutures were removed 4 weeks after the surgery. Six months post surgery, the graft was clear and the patient rehabilitated by wearing acceptable astigmatic spectacle correction.

Results

The patients visual acuity in the affected eye was 6/12 wearing a spectacle prescription of −0.25/−3.25×160.

Conclusion

The use of overlay sutures and fibrin glue in DLK is a time efficient and effective technique. We propose that this technique may be used routinely in cases where donor corneal button appears to fit well in the stromal bed at the time of surgery, that is, where there is no disparity in the thickness of the donor button compared to the host bed.

Keywords: Deep anterior lamellar keratoplasty, Fibrin glue, Infective keratitis, Overlay sutures