Penetrating Keratoplasty

Donor Preparation Recipient Preparation Suturing Technique

A. A scarred cornea about to receive a corneal transplant. B. Trephining of the recipient from the epithelial side with a suction trephine. The inner trephine rotates to achieve a measured depth cut. C. Trephining of the donor button from the endothelial side. The cornea is frequently held by a suction base. The cut is achieved by plunge cutting (pressure squeezing the corneal donor between the trephine and base). D. The patient's cornea is removed and the donor button is transferred to the recipient bed. E. The donor is sutured to the recipient with interrupted sutures generally of 10-0 nylon.

F. The donor tissue is held in place with four interrupted cardinal sutures. G. A running or many other interrupted sutures are placed to complete the suturing of the transplant.  The sutures are usually left in place for a year or longer to allow healing of the graft host junction. (Appendix 4 - Figure 1)

A running closure uses one piece of suture which is passed through the tissue with many "bites", commonly 8, 12, 16, 20 or 24.

The interrupted closure is shown above with a Khoudadoust rejection line (arrows).  The line is made up of keratic precipitates seen only on the donor endothelium. This represents the recipient attacking the foreign endothelial cells on the donor tissue.

   

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