title: Corneal topography-guided penetrating keratoplasty and suture adjustment: new approach for astigmatism control.
abstract: OBJECTIVE
  To describe a new keratoplasty procedure using intraoperative topography to reduce postoperative astigmatism.
  
  
  METHODS
  One hundred sixty-five eyes of 150 consecutive patients were enrolled in this prospective study. The most common diagnosis was keratoconus (78.8%). As many as 5.5% had post-laser in situ keratomileusis ectasia. Keratoplasty was performed with the Hanna Corneal Trephine System. A 24-bite running suture was placed, using a specially developed marker. Suture adjustment was performed with the aid of an intraoperative topographer (Keratron Scout; OPTIKON 2000, Rome, Italy). The aim of the adjustment was to obtain an astigmatism < or =2.0 D on the operating table. In case of >3.0 D of astigmatism at 1 month after surgery, suture adjustment was performed using the same intraoperative topographer.
  
  
  RESULTS
  At 12 months postoperatevely (suture in), data from 108 (64%) eyes were available. The mean refractive astigmatism was 3.53 D, and the mean topographical astigmatism was 4.7 D. At 18 months (suture out), data from 32 eyes (19.4%) were available, and at 24 months, data from 29 eyes (13.3%) were available. The mean refractive astigmatism was 3.39 D at 18 months and 3.47 D at 24 months. The mean topographic astigmatism was 2.30 D at 18 months and 1.76 D at 24 months. Mean best spectacle-corrected visual acuity (BSCVA) was 0.51 at 3 months, 0.63 at 12 months (suture in), 0.67 at 18 months (suture out), and 0.78 at 24 months postoperatively.
  
  
  CONCLUSIONS
  The combination of intraoperative topography and a 24-bite single running suture resulted in a stable astigmatism throughout the follow-up period, even after suture removal. BSCVA reached a 20/40 level as early as 3 months postoperatively and continued to rise after suture removal. The stability of astigmatism and BSCVA shortened the postoperative visual rehabilitation time and provided a high quality of vision early in the postoperative period.
authors.affiliation: Istituto Clinico Humanitas, Rozzano, Italy. info@vincieye.it
authors.forename: Paolo
authors.initials: P
authors.lastname: Vinciguerra
authors.forename: Daniel
authors.initials: D
authors.lastname: Epstein
authors.forename: Elena
authors.initials: E
authors.lastname: Albè
authors.forename: Fernando
authors.initials: F
authors.lastname: Spada
authors.forename: Nadia
authors.initials: N
authors.lastname: Incarnato
authors.forename: Nicola
authors.initials: N
authors.lastname: Orzalesi
authors.forename: Pietro
authors.initials: P
authors.lastname: Rosetta
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001251:Astigmatism / Q000517:prevention & control*; D019781:Corneal Topography / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015948:Keratoplasty, Penetrating / Q000379:methods*; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D011446:Prospective Studies; D013536:Suture Techniques; D014792:Visual Acuity