Fibrin Glue for Opposing Wound Edges in “Top Hat” Penetrating Keratoplasty

Abstract

To evaluate the advantages of fibrin glue for opposing wound edges in Top Hat penetrating keratoplasty (PKP). Twenty human corneoscleral rims were mounted on an artificial anterior chamber. Eight corneas underwent traditional PKP, 6 underwent Top Hat PKP, and 6 underwent Top Hat PKP by using fibrin glue for opposing wound edges. Mechanical stability was evaluated after placement of 8 and 16 interrupted sutures. Wound bursting pressure and induced astigmatism were evaluated. In the traditional PKP group, wound bursting pressure was 25.2 and 59.1 mm Hg after placement of 8 and 16 sutures, respectively. In the Top Hat PKP, leakage occurred at 57.6 and 103.8 mm Hg after placement of the 8 and 16 sutures, respectively. In the Top Hat PKP + fibrin glue group, wound leakage occurred at 144.6 mm Hg after placement of the 8 sutures and at >158 mm Hg after placement of 16 sutures. The Top Hat PKP + fibrin glue group induced astigmatism of 2.5 D, whereas the traditional PKP group and the Top Hat PKP group showed an induced astigmatism of 3.1 D each. The use of fibrin glue in Top Hat PKP was found to be more mechanically stable than traditional sutures.