Digital Marking Of Suture Site In Penetrating Keratoplasty, Is It Time?

Published 2022 - 40th Congress of the ESCRS

Reference: FPS12.12 | Type: Free paper | DOI: 10.82333/ad79-br44

Authors: Ahmed AR Shalash* ¹ , Mohamed ElBahrawy ²

¹Shalash eye clinic,Cairo,Egypt, ²Watany Research and Development Center (WRDC), Cairo, Egypt.,cairo,Egypt

Purpose

Marking of suture site during penetrating keratoplasty surgery is extremely important. Correct and equidistant placement of suture ensures good wound coaptation, proper healing and eliminates many suture related complications. We aim to describe a novel technique for marking of suture site in penetrating keratoplasty where traditional manual markers fail.

Setting

Eye subspeciality center, Cairo, Egypt. Cornea and refractive surgery department

Methods

6 eyes from 6 patients scheduled for Femotlasik assisted penetrating keratoplasty (Fs PKP) underwent full ophthalmological examination. All 6 eyes had advanced keratoconus. Mean best corrected visual acuity was 0.1 . Mean central corneal thickness was 360 microns. Mean Keratometer (K) reading was 55.6 . One eye had corneal apex scarring.

All eyes were imaged using the VERION Reference Unit (Alcon, Fort Worth, TX, USA). Data was transferred intraoperatively to the VERION Digital Marker (VDM) linked to the surgical microscope and used to display a realtime image overlying the patient’s cornea. This image was used to place 12 interrupted sutures to secure the donor cornea with no need for using a manual marker to mark the site of the sutures.

Results

6 out of 6 cases where we performed digital marking of suture site showed excellent wound coaptation 1st day postoperatively. No eyes showed shallowing of the anterior chamber or iris prolapse through the corneal wound.

All sutures appeared to be placed at equal distances with no signs of postoperative wound leakage or wound dehiscence.

1st week, one month, 3 months and 6 months post operative follow-up showed excellent corneal healing with no signs of suture related complications.

Conclusions

In our hands, the use of the VERION imaging system for suture marking in penetrating keratoplasty appears to be a very reliable tool that ensures good wound healing with optimized surgical and visual outcomes for corneal keratoplasty patients. Our method avoids many drawbacks of manual marking, such as fading of manual marks throughout the surgery and difficulty of corneal marking in complicated cases.

Though a reliable device, The VERION system was not designed for this purpose, and with many surgical procedures already relying on virtual imagery, a call for a dedicated device or software for digital marking of suture site will facilitate keratoplasty surgeries in the future.