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NAWAF’S modified graft over host technique to counter positive posterior pressure (PPP) during penetrating keratoplasty (PKP)

Poster Details

First Author: N.Alqahtani SAUDI ARABIA

Co Author(s):                        

Abstract Details


To describe a modified graft-over-host (MGOH) surgical technique to prevent serious complications in cases of positive vitreal pressure during penetrating keratoplasty (PKP) and to compare the endothelial cell loss(ECL) and clinical outcome between eyes undergoing MGOH or standard PKP.


King Abdullah Medical City, Makkah, Saudi Arabia


After 90 deg. full cutting of the host cornea, if PPP occurred, this quadrant is secured by one suture. Then adjacent quadrant is cut and secured again with a suture till the host cornea is entirely separated but still remain sutured by 4 sutures. The graft is then placed over the host button and sutured to the rim of the host cornea with 4 sutures, each in between the previous 4 sutures. The host button is then delivered out. Graft is then sutured with 12 more sutures.Grafts were prospectively followed up for clarity, ECL and astigmatism.


Of 220 cases scheduled for standard PKP in years 2009–2012, eight were operated by MGOH technique.Despite the fact that the donor cornea is situated over the recipient throughout the whole MGOH procedure, there was no significant difference in endothelial cell loss, graft clarity and amount of astigmatism between eyes operated on by MGOH technique and standard PKP, and none of the grafts had primary graft failure.


Modified graft-over-host technique seems to be a safe and effective method to prevent complications during PKP complicated by positive vitreal pressure.

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