title: Surgical technique for control of postkeratoplasty myopia, astigmatism, and anisometropia.
abstract: OBJECTIVE
  We previously demonstrated that selective suture removal reduces keratoplasty astigmatism; however, a myopic shift was induced with the increasing number of interrupted sutures removed. This study is an attempt to determine the effects of a modified surgical technique on postkeratoplasty myopia, astigmatism, and anisometropia.
  
  
  METHODS
  A cohort study compared with historical controls.
  
  
  METHODS
  Optical penetrating keratoplasties were performed on 92 eyes of 84 patients. The study group consisted of 92 consecutive penetrating keratoplasties performed using 12 interrupted 10-0 nylon sutures and a tight 12-bite continuous suture and an average K reading of 46.00 diopters for eyes undergoing combined and intraocular lens exchange procedures. All patients had refraction, keratometry, and videokeratoscopy postoperatively starting at 6 weeks and at the completion of selective suture removal.
  
  
  RESULTS
  Before suture removal, the average spherical equivalent was -0.160 +/- 3.59 diopters; it was -1.58 +/- 3.66 diopters at the completion of suture removal at 1 year and -1.44 +/- 3.72 at the last follow-up visit, averaging 20.7 months. Final refractive, keratometric, and videokeratoscopy astigmatism was 2.81 +/- 1.82, 4.19 +/- 2.94, and 3.58 +/- 2.03 diopters, respectively. Anisometropia, using the spherical equivalent of the operated and fellow eyes, was 2.49 +/- 2.25 diopters at completion of the study. A best-corrected visual acuity of 20/50 or better was achieved in 59% of patients.
  
  
  CONCLUSIONS
  Low myopic spherical equivalent and anisometropia were achieved using a K reading of 46 diopters for calculation of intraocular lens power. The use of tighter continuous sutures and selective removal of fewer interrupted sutures only served to increase final astigmatism, with no significant effect on the final spherical equivalent.
authors.affiliation: Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami, School of Medicine, Miami, Florida 33101, USA.
authors.forename: Dilek
authors.initials: D
authors.lastname: Dursun
authors.forename: Richard K
authors.initials: RK
authors.lastname: Forster
authors.forename: William J
authors.initials: WJ
authors.lastname: Feuer
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015858:Anisometropia / Q000517:prevention & control*; D001251:Astigmatism / Q000517:prevention & control*; D019781:Corneal Topography; D005260:Female; D006801:Humans; D015948:Keratoplasty, Penetrating; D008297:Male; D008875:Middle Aged; D009216:Myopia / Q000517:prevention & control*; D009757:Nylons; D011183:Postoperative Complications / Q000517:prevention & control*; D013536:Suture Techniques; D013537:Sutures; D014792:Visual Acuity
chemical_list: D009757:Nylons