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

Richard MH Lee,¹ Fook Chang Lam,¹ Tassos Georgiou,¹ Bobby Paul,¹ Kong Yong Then,¹ Ioannis Mavrikakis,¹ Venkata S Avadhanam,¹ Christopher SC Liu<sup>1,2

1</sup>Sussex Eye Hospital, Brighton, United Kingdom; ²Tongdean Eye Clinic, Hove, United Kingdom

Aims: To report on the suturing techniques and aspects of postoperative management in penetrating keratoplasty in the United Kingdom.
Methods: A 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.
Results: In 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.
Conclusion: This 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.

Keywords: corneal graft, penetrating keratoplasty, anterior segment surgery, cornea, corneal surgery, corneal transplantation