title: Suturing in lamellar surgery: the BRA-technique.
abstract: BACKGROUND
  The principle of refractive corneal lamellar surgery rests on the modification of corneal shape after the removal of a superficial disk with a microkeratome. The 150-microns-thick disk is easily torn, rotated or decentered by the traditional eight-bite running suture, producing irregular astigmatism which is the major cause of visual deficit after these procedures.
  
  
  METHODS
  We propose a new suture technique, designated the BRA suture, which we have used in more than 300 cases of various types of refractive corneal lamellar procedures. Based on the overlay concept, the suture is anchored in four points of the nonoperated corneal periphery.
  
  
  RESULTS
  With this technique, the iatrogenic irregular astigmatism induced by the suture has been eliminated and corneal scars significantly reduced. This suture also decreases surgical time, accelerates visual recovery, and increases patient comfort due to its early removal.
  
  
  CONCLUSIONS
  We consider this the ideal suture for refractive corneal lamellar surgery due to its effectiveness, simplicity, and safety.
authors.affiliation: Clinica de Microcirurgia Ocular, Belo Horizonte, Brazil.
authors.forename: R Q
authors.initials: RQ
authors.lastname: Guimaräes
authors.forename: J J
authors.initials: JJ
authors.lastname: Rowsey
authors.forename: M F
authors.initials: MF
authors.lastname: Guimaräes
authors.forename: P P
authors.initials: PP
authors.lastname: Reis
authors.forename: R D
authors.initials: RD
authors.lastname: Castro
authors.forename: B R
authors.initials: BR
authors.lastname: Tirado
mesh_terms: D001251:Astigmatism / Q000517:prevention & control; D016039:Corneal Transplantation / Q000379:methods*; D006801:Humans; D054140:Refractive Surgical Procedures; D013536:Suture Techniques; D014792:Visual Acuity; D014945:Wound Healing