Refinement of the Graft-over-Host Technique in Penetrating Keratoplasty

Purpose: We describe a refinement of the graft-over-host technique that eliminates the open-sky phase and reduces the use of additional sutures beyond what is needed for the traditional open-sky technique. Methods: This study is a surgical technique description and retrospective case review. For surgical technique, first, trephinate the recipient cornea to 90% depth. Dissect the cornea button, preserving the cardinal attachments. Secure the donor disc over the recipient cornea button with cardinal sutures. Complete the dissection of the cardinal attachments on the underlying recipient cornea button. Slide the recipient cornea button out from under the donor cornea disc. Place additional sutures for the additional securitization of donor disc. For data collection and analysis of surgical outcomes, we conducted a retrospective chart review for 35 patients who underwent the traditional open-sky technique and 28 patients who underwent the graft-over-host technique. Results: There were no cases of intraoperative complications including suprachoroidal hemorrhage and vitreal prolapse between both open-sky and graft-over-host cohorts. There were no significant differences in visual acuity between the cohorts at 6-month and 1-year follow-ups. Conclusions: Although penetrating keratoplasty may be an increasingly less common surgery, the risks associated with the open-sky phase persist. Surgeons may consider using the graft-over-host technique described in this study to reduce intraoperative risk while minimizing suture utilization, tissue manipulation, and associated operative time.