title: Suturing techniques and postoperative management in penetrating keratoplasty in the United Kingdom.
abstract: OBJECTIVE
  To report on the suturing techniques and aspects of postoperative management in penetrating keratoplasty in the United Kingdom.
  
  
  METHODS
  A postal questionnaire was sent to 137 ophthalmic consultants identified from a Royal College of Ophthalmology database as having a special interest in anterior segment surgery. The questionnaire surveyed surgeon preferences for surgical and suturing technique for penetrating keratoplasty surgery, and the postoperative care of corneal grafts.
  
  
  RESULTS
  In all, 68% of questionnaires were completed and returned: 73% of respondents used a Flieringa ring or equivalent, 94% routinely used cardinal sutures, with 50.5% removing them at the end of the procedure. The most common suturing technique for routine penetrating keratoplasty was a single continuous suture (35%). In these cases, a 10/0 nylon suture was used by 89%. Sixty-six percent changed their technique in high-risk cases, 52% used a 3-1-1 knot, and 75% made a distinction between a reef and granny knot, with 76% using a reef. Thirty percent buried the knots within the donor material, and 29% within the host tissue. Twenty-five percent had no routine time for graft suture removal, but 41% removed them between 1 and 2 years post-surgery. After suture removal, 98% used steroids and 88% used topical antibiotics. Thirty-four percent stopped topical steroids before suture removal, with 38% stopping topical steroids more than 3 months prior to suture removal.
  
  
  CONCLUSIONS
  This survey demonstrates that there is considerable variation in suturing techniques and postoperative care for penetrating keratoplasty. These significant variations in practice need to be considered when interpreting outcomes and research.
authors.affiliation: Sussex Eye Hospital, Brighton, United Kingdom.
authors.forename: Richard Mh
authors.initials: RM
authors.lastname: Lee
authors.forename: Fook Chang
authors.initials: FC
authors.lastname: Lam
authors.forename: Tassos
authors.initials: T
authors.lastname: Georgiou
authors.forename: Bobby
authors.initials: B
authors.lastname: Paul
authors.forename: Kong Yong
authors.initials: KY
authors.lastname: Then
authors.forename: Ioannis
authors.initials: I
authors.lastname: Mavrikakis
authors.forename: Venkata S
authors.initials: VS
authors.lastname: Avadhanam
authors.forename: Christopher Sc
authors.initials: CS
authors.lastname: Liu