Photochemical keratodesmos as an adjunct to sutures for bonding penetrating keratoplasty corneal incisions Cinthia E. Proano, MD, Dimitri T. Azar, MD, Mehmet Cem Mocan, MD, Robert W. Redmond, PhD, Irene E. Kochevar, PhD Purpose: To evaluate the benefit of photochemical keratodesmos (PKD) in acute wound closure of penetrating keratoplasty (PKP) corneal incisions in vivo. Setting: Massachusetts General Hospital and Massachusetts Eye and Ear Infir- mary, Boston, Massachusetts, USA. Methods: Penetrating keratoplasty incisions were performed in both eyes of 6 New Zealand white rabbits, followed by application of 1.5 mM rose bengal dye at the wound edges. The incision in 1 eye of each rabbit was irradiated with neodym- ium:YAG laser light at 532 nm and fluence of 40 J/cm 2 ; the contralateral control eye was untreated. Intraocular pressure at which fluid leaked at the edges (IOP L ) was determined immediately after surgery. Results: The mean IOP L was 410 mm Hg  70 (SD) in the PKD-treated eyes and 250  150 mm Hg in the unirradiated eyes. The difference was statistically sig- nificant by paired t test (P.05). Conclusions: Photochemical keratodesmos may be a useful adjunct to sutures for approximating PKP corneal incisions in the immediate postoperative period. This process does not induce high temperature, and thus denaturation can be avoided and structural integrity restored. J Cataract Refract Surg 2004; 30:2420–2424  2004 ASCRS and ESCRS quent. The use of suturing as the bonding method is P enetrating keratoplasty (PKP) is a commonly per- the source of many complications. 1–8 The presence of formed organ transplantation procedure. Results sutures and exposed knots form a nidus for infection are often satisfactory, but outcome failures are also fre- from bacteria, viruses, and fungi. 9–14 Microbial keratitis develops in 12% of eyes PKP. 15, 16 The use of 10-0 nylon sutures may also retard the wound-healing process. 17 A Accepted for publication February 18, 2004. single loose suture may lead to wound displacement From the Massachusetts Eye and Ear Infirmary and the Schepens Eye because of the innate elasticity of nylon. Sutures that Research Institute, Massachusetts General Hospital (Proano, Azar, Mo- are too loose or too tight may cause astigmatism, which can), and the Wellman Laboratories of Photomedicine, Harvard Medi- could limit visual acuity. 18,19 Because the wound does cal School (Proano, Redmond, Kochevar), Boston, Massachusetts. not heal completely, sutures are often left in place None of the authors has a financial interest in any product mentioned. for years. Finally, suture removal is a possible factor in Supported by the DoD Medical Free Electron Laser Program, contract the inducement of graft rejection. Thus, because sutur- number F 49620-01-1-0014, and the DoE, contract number DoE- ing as the bonding method is the source of potential FG02-91ER61228. complications, it would be beneficial to have a proce- Reprint requests to Dimitri T. Azar, MD, Director, Corneal and dure for corneal transplantation that does not involve Refractive Surgery Services, Massachusetts Eye and Ear Infirmary, 243 the use of sutures or that allows early removal of all Charles Street, Boston, Massachusetts 02114, USA. E-mail: dazar@ meei.harvard.edu. sutures.  2004 ASCRS and ESCRS 0886-3350/04/$–see front matter Published by Elsevier Inc. doi:10.1016/j.jcrs.2004.02.068