title: Effect of disagreement between refractive, keratometric, and topographic determination of astigmatic axis on suture removal after penetrating keratoplasty.
abstract: OBJECTIVE
  Post-keratoplasty astigmatism can be managed by selective suture removal in the steep axis. Corneal topography, keratometry, and refraction are used to determine the steep axis for suture removal. However, often there is a disagreement between the topographically determined steep axis and sutures to be removed and that determined by keratometry and refraction. The purpose of this study was to evaluate any difference in the effect of suture removal, on visual acuity and astigmatism, in patients where such a disagreement existed.
  
  
  METHODS
  37 cases (from 37 patients) of selective suture removal after penetrating keratoplasty, were included. In the first group "the disagreement group" (n=15) there was disagreement between corneal topography, keratometry, and refraction regarding the axis of astigmatism and sutures to be removed. In the second group "the agreement group" (n=22) there was agreement between corneal topography, keratometry, and refraction in the determination of the astigmatic axis and sutures to be removed. Sutures were removed according to the corneal topography, at least 5 months postoperatively. Vector analysis for change in astigmatism and visual acuity after suture removal was compared between groups.
  
  
  RESULTS
  In the disagreement group, the amount of vector corrected change in refractive, keratometric, and topographic astigmatism after suture removal was 3.45 (SD 2.34), 3.57 (1.63), and 2.83 (1. 68) dioptres, respectively. In the agreement group, the amount of vector corrected change in refractive, keratometric, and topographic astigmatism was 5.95 (3.52), 5.37 (3.29), and 4.71 (2.69) dioptres respectively. This difference in the vector corrected change in astigmatism between groups was statistically significant, p values of 0.02, 0.03, and 0.03 respectively. Visual acuity changes were more favourable in the agreement group. Improvement or no change in visual acuity occurred in 90.9% in the agreement group compared with 73.3% of the disagreement group.
  
  
  CONCLUSIONS
  Agreement between refraction, keratometry, and topography was associated with greater change in vector corrected astigmatism and was an indicator of good prognosis. Disagreement between refraction, keratometry, and topography was associated with less vector corrected change in astigmatism, a greater probability of decrease in visual acuity, and a relatively poor outcome following suture removal. However, patients in the disagreement group still have a greater chance of improvement than worsening, following suture removal.
authors.affiliation: Division of Ophthalmology and Visual Sciences, University of Nottingham, University Hospital, Queen's Medical Centre, Nottingham NG7 2UH.
authors.forename: A R
authors.initials: AR
authors.lastname: Sarhan
authors.forename: H S
authors.initials: HS
authors.lastname: Dua
authors.forename: M
authors.initials: M
authors.lastname: Beach
mesh_terms: D001251:Astigmatism / Q000209:etiology / Q000517:prevention & control*; D019781:Corneal Topography; D005260:Female; D006801:Humans; D015948:Keratoplasty, Penetrating / Q000009:adverse effects*; D008297:Male; D011446:Prospective Studies; D012029:Refraction, Ocular / Q000502:physiology*; D013536:Suture Techniques / Q000009:adverse effects / Q000592:standards*; D016896:Treatment Outcome; D014792:Visual Acuity / Q000502:physiology*