title: Comparison of the effect of three suturing techniques on postkeratoplasty astigmatism in keratoconus.
abstract: OBJECTIVE
  To compare the effect of 3 common suturing techniques on postkeratoplasty astigmatism and final best corrected visual acuity (BCVA) in patients with keratoconus.
  
  
  METHODS
  In this randomized clinical trial, 103 eyes of 103 patients with advanced keratoconus, who were contact lens intolerant, or with contact lens-corrected visual acuity less than 20/80, underwent penetrating keratoplasty with 3 suturing techniques: interrupted (IR), single running (SR), and combined interrupted and running (CIR). Postkeratoplasty astigmatism and BCVA were evaluated during regular examinations 1.5, 3, 6, and 12 months postoperatively and 2 months after complete suture removal. Suture adjustment and selective suture removal were performed 2 to 6 weeks and after 3 months in eyes with more than 4 D of corneal astigmatism in the SR and IR/CIR groups, respectively.
  
  
  RESULTS
  Of 87 patients who completed follow-up, 26 eyes underwent PK with interrupted suturing technique (IR), 26 eyes had single running sutures (SR), and in 35 eyes, the suturing technique was combined (interrupted + running sutures; CIR). Mean age was 27.2 +/- 8.4, 28.9 +/- 8.7, and 30.3 +/- 8.7 years, and postoperative astigmatism 1.5 months after surgery was 3.77 +/- 1.68, 5.48 +/- 2.09, and 4.10 +/- 1.79 D in the 3 groups, respectively (P = 0.015). However, 2 months after complete suture removal, final postoperative astigmatism was 3.83 +/- 1.65, 3.37 +/- 1.9, and 3.88 +/- 2.79 D (P = 0.851) and BCVA (log MAR) was 0.08 +/- 0.14, 0.13 +/- 0.23, and 0.09 +/- 0.16, respectively (P = 0.53). Immunologic endothelial rejection reactions were seen in 5 eyes (19.2%) in the IR group, 3 eyes (11.72%) in the SR group, and 6 eyes (17.64%) in the CIR group (P = 0.44). There was no case of graft failure during the follow-up period.
  
  
  CONCLUSIONS
  Postkeratoplasty astigmatism and BCVA are comparable with the 3 common suturing techniques (IR, SR, and CIR) in patients with keratoconus, provided that regular postoperative examinations and topography-guided suture adjustment and/or removal are performed.
authors.affiliation: Ophthalmology Department, Labbafinejad Medical Center, Shaheed Beheshti University of Medical Sciences, Tehran, Iran. ma_javadi@yahoo.com
authors.forename: Mohammad Ali
authors.initials: MA
authors.lastname: Javadi
authors.forename: Mostafa
authors.initials: M
authors.lastname: Naderi
authors.forename: Mohammad
authors.initials: M
authors.lastname: Zare
authors.forename: Ahmad
authors.initials: A
authors.lastname: Jenaban
authors.forename: Hossein Mohammad
authors.initials: HM
authors.lastname: Rabei
authors.forename: Arash
authors.initials: A
authors.lastname: Anissian
mesh_terms: D000328:Adult; D001251:Astigmatism / Q000503:physiopathology*; D003315:Cornea / Q000503:physiopathology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007640:Keratoconus / Q000601:surgery*; D015948:Keratoplasty, Penetrating; D008297:Male; D011182:Postoperative Care; D011183:Postoperative Complications; D013536:Suture Techniques; D014792:Visual Acuity / Q000502:physiology