title: Refractive and keratometric results after the triple procedure: experience with early and late suture removal.
abstract: OBJECTIVE
  The objective of this study was to determine the outcome of early and late suture removal after the triple procedure (i.e., penetrating keratoplasty, cataract extraction, lens implant).
  
  
  METHODS
  The refractive and keratometric results of 106 eyes undergoing the triple procedure were reviewed. The target postoperative refractive error was -1 diopter (D).
  
  
  RESULTS
  Average length of follow-up was 40.3 months. Twenty eyes had sutures removed early (<18 months after surgery), 39 had sutures removed late (> or = 18 months after surgery), and 47 had sutures still intact at last follow-up. A best spectacle-corrected visual acuity of 20/40 or better was achieved in 90% of eyes with sutures removed early, 82.1% with sutures removed late, and 70.2% with sutures in place. For all eyes, the mean spherical equivalent at last follow-up was -2.50 D, with 75% of eyes falling between -4 and +2 D. The mean final refractive error was -3.40 +/- 3.53 D for eyes with sutures removed early and -1.79 +/- 3.99 D for eyes with sutures removed late. Eyes with sutures remaining had a mean final refractive error of -0.33 +/- 2.25 D. There was an overall decrease in refractive and keratometric astigmatism after both early and late suture removal with no significant difference between groups. However, there was a wide range of change with some eyes experiencing a decrease and others an increase in astigmatism. Mean postoperative K readings increased significantly for both groups after suture removal (final mean K, 47.00 D) but remained stable for eyes with sutures in.
  
  
  CONCLUSIONS
  The authors data suggest that the final refractive error and net change in refractive and keratometric astigmatism after the triple procedure are not dependent on the timing of suture removal.
authors.affiliation: Corneal and Refractive Surgery Service, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston 02114, USA.
authors.forename: E A
authors.initials: EA
authors.lastname: Davis
authors.forename: D T
authors.initials: DT
authors.lastname: Azar
authors.forename: F M
authors.initials: FM
authors.lastname: Jakobs
authors.forename: W J
authors.initials: WJ
authors.lastname: Stark
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001251:Astigmatism / Q000503:physiopathology; D019923:Capsulorhexis; D002386:Cataract / Q000150:complications; D005260:Female; D005500:Follow-Up Studies; D005642:Fuchs' Endothelial Dystrophy / Q000150:complications / Q000601:surgery; D006801:Humans; D007431:Intraoperative Complications; D015948:Keratoplasty, Penetrating; D019654:Lens Implantation, Intraocular; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D013536:Suture Techniques; D016896:Treatment Outcome; D014792:Visual Acuity / Q000502:physiology