Ozkan, Kaan; Aydın, Bahri; Ucgul, Ahmet Yucel; Bayrakceken, Kemal; Ozmen, Mehmet Cuneyt; Akata, Rustu Fikret

Purpose: This study aimed to assess the effectiveness of an innovative intrastromal suturing technique in an experimental rabbit model, comparing it to standard interrupted suturing, loose suture, and suturing with knot exposure. Methods: Fourteen adult male New Zealand White rabbits were included in this study. Each rabbit underwent suturing in both eyes, divided into four groups based on suturing techniques. The novel intrastromal suturing technique involved burying the entire suture material within the corneal stroma. Corneal neovascularisation (CoNV) areas were evaluated by image analysis and immune cell densities by in vivo confocal microscopy (IVCM). Results: The intrastromal suturing group demonstrated significantly smaller CoNV areas at both 1 week and 1 month post-suturing compared to other interventional groups, indicating effective mitigation of CoNV development and progression. Moreover, this group exhibited lower immune cell densities in the superficial stromal layer and endothelial layer, suggesting a reduced inflammatory response. Both the loose suture and the knot exposure groups exhibited significant levels of CoNV and heightened immune cell densities. Conclusion: This experimental study demonstrated effectiveness of intrastromal suturing technique in limiting CoNV and immune cell infiltration, common contributors to graft rejection and complications. Furthermore, the study revealed that loose sutures and those with exposed knots are likely to cause more severe CoNV and inflammation, compared to the traditional interrupted suturing technique and intrastromal suturing.