Reverse graft suturing to avoid Descemet's membrane detachment of glycerol-preserved donor cornea used for therapeutic penetrating keratoplasty during COVID-19 to overcome the tissue shortage - A novel surgical technique

为应对新冠疫情期间组织短缺,一种新型手术技术——反向缝合技术,用于治疗性穿透性角膜移植术,避免甘油保存的供体角膜发生后弹力层脱离。

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Abstract

To overcome tissue shortage during pandemic, we switched to 100% glycerol preservation of the donor cornea, which is economical and provides longer duration of storage than the short and intermediate storage mediums we normally use like McCAREY Kaufman (MK) or cornisol. During our initial few cases of therapeutic penetrating keratoplasty using glycerol preserved donor cornea, we faced spontaneous Descemet's detachments resistant to air tamponade. We tried reverse graft suturing and successfully reinforced Descemet's attachment along with air tamponade, in one of the cases after multiple failed air injections. In the subsequent two cases of infective keratitis needing therapeutic penetrating Keratoplasty, we took eight reverse sutures in between the eight cardinals, to anchor the Descemet's membrane of the graft. Both the grafts showed attached Descemet's and maintained good graft clarity. The reverse corneal suturing technique has not been described to the best of our knowledge and hope this helps our corneal fraternity.

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