Postoperative suture manipulation for control of corneal graft astigmatism.
OBJECTIVE
To assess the effect on post-keratoplasty astigmatism of postoperative manipulation of a single running suture.


METHODS
All corneal transplant patients in whom a single 10/0 nylon running suture was placed between November 1990 and April 1996 were included in a prospective study of the effect of manipulation of the suture at the earliest possible time after surgery when the keratometry became possible by virtue of the epithelial surface integrity and where this revealed astigmatism of greater than 2 D.


RESULTS
One hundred and ninety eyes underwent suture manipulation and were followed up. Follow up on 30 eyes was discontinued. Repeat manipulation of the running suture was the most common reason for discontinuation of follow up. The remaining patients were followed for a mean (+/- SD) 415.5+/-326.4 days. Mean astigmatism of 7.8+/-3.1 D was reduced to 1.7+/-2.0 D immediately after manipulation, but regressed to 3.0+/-1.9 D (n = 76) by 1 year. The suture was removed in 32 patients. Twenty-five eyes had post-removal astigmatism measurements. In these 25 eyes, astigmatic error appeared not to revert to premanipulation levels. The only significant complication was one broken suture at manipulation.


CONCLUSIONS
Early suture manipulation is effective in reducing suture in post-keratoplasty astigmatism, but some regression is seen.
Department of Surgery, University of Queensland, Princess Alexandra Hospital, Woolloongabba, Australia.
L W
LW
Hirst
J A
JA
McCoombes
M
M
Reedy
D001251:Astigmatism / Q000209:etiology / Q000517:prevention & control*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015948:Keratoplasty, Penetrating / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009757:Nylons; D011182:Postoperative Care / Q000379:methods*; D011446:Prospective Studies; D012008:Recurrence; D013536:Suture Techniques; D013537:Sutures
D009757:Nylons