The challenge in performing a penetrating keratoplasty (PK) is to place the sutures for donor cornea fixation in a waythat no additional postoperative iatrogenic astigmatism is induced, preventing persistent vision deterioration.

One option, which proved itself throughout the history of corneal transplantation, is to fixate the corneal transplantthrough a running cross stitch suture – the double running crossed diagonal suture by Hoffmann with 2 x 8 bites.

As the name suggests, the challenges of this suture technique lie in the precision required to exactly place the stitches.In addition, the technique requires a precise visual estimate for gauging the dimensions, which is often associatedwith a shallow (long and tedious) training curve. Therefore the desired results are not always achieved.


The cross stitch suture marker by Suffo in the shape of number 7

Vertical visual mark (M1)of the arc and horizontalvisual mark (M2) of thelong side indicate the rightradial alignment of thesuture marker

Marking tips on both endsof the long side indicatethe suture entry (B) andexit points (C)


  • Precise marking of the needle entry and exit points
  • Homogenous running cross stitch suture
  • Highly reproducible
  • Short training curve
  • High safety for the surgeon through independence of visual estimate
  • Neutral astigmatism
  • Reduced risk of a vertikal tilt or horizontal torsion of the donor when suturing
  • High topographic regularity (regular astigmatism)
  • Low rate uf suture loosening
  • Early visual rehabilitation
  • Reduction of gaping inner and outer wound margins
  • Reduced rate of suture repositioning


1. Provisional fixation of the donor cornea
Use an 8-blade corneal transplant marker to place the provisionalcardinal sutures with simple interrupted stitches.
2. Marking the first running suture (red dots)
For marking the needle entry and exit points of the first runningsuture, align the visual marks M1 and M2 with the cardinal suture,so that M2 sits at the transplantation edge (interface).
3. Repeating the markings (red dots)
Repeat this type of marking eight times along each cardinal suture.
4. Positioning the first running suture (red lines)
Perform the first running suture along the red dots in a star-shapedpattern. The dots on the donor cornea constitute the suture entrypoints. The dots on the recipient cornea (close to the limbus) constitutethe suture exit points. The dashed lines indicate suture passage belowthe cornea, whereas continuous lines indicate suture passage abovethe cornea.
5. Marking the second running suture (green dots)
For marking the needle entry and exit points of the second runningsuture, the instrument needs to be placed exactly in between twocardinal sutures. Align the left end of the arc (A) with the entry pointof the first running suture, and align M2 with the first running sutureat the interface. Repeat this type of marking eight times along thefirst running suture.
6. Positioning the second running suture (green lines)
Perform the second running suture along the green dots in a starshapedpattern, as well. The dots on the donor cornea constitutethe suture entry points. The dots on the recipient cornea (close tothe limbus) constitute the suture exit points.
7. Removing the cardinal sutures
Remove the cardinal sutures after the double running suture is in place.
8. Result
The result is a neat and evenly double running suture by Hoffmann,crossing each other at the interface.

Product Information for download