title: Rapid suture management of post-keratoplasty astigmatism.
abstract: OBJECTIVE
  Post-keratoplasty astigmatism is managed by topography-guided suture removal. This can take several weeks until satisfactory reduction in astigmatism is achieved. This study aimed to assess whether topography performed 30-40 min after the removal of the first pair of sutures would predict the next set of sutures requiring removal.
  
  
  METHODS
  A prospective study of 20 consecutive penetrating keratoplasty patients was carried out. Topography guided suture removal in the steep meridian was carried out. Topography was repeated after 30-40 min and 4-6 weeks later. The tight sutures requiring removal were identified for each occasion and compared. The difference was considered insignificant if the axes of sutures requiring removal was <22.5 degrees. Paired t-test and chi (2) were performed for statistical analysis.
  
  
  RESULTS
  In 85% of individuals, the 30-40 min topography gave an accurate indication of the next pair of sutures requiring removal. The difference in mean astigmatism at 30-40 min post suture removal (4.37+/-2.08 D) and at 4-6 weeks (4.24+1.97 D) was not significant (P=0.150). However, the difference between vector-corrected change of topographic astigmatism at 30-40 min after suture removal and at 4-6 weeks (1.72 D) was significant (P<0.001). Improved best-corrected visual acuity was seen in 50% of patients.
  
  
  CONCLUSIONS
  This study showed that corneal topography performed 30-40 min after suture removal can identify the next set of sutures requiring removal. This can be used as a guide to remove more sutures at the same visit, thereby expediting post-keratoplasty visual rehabilitation and reducing the number of follow-up visits.
authors.affiliation: Department of Ophthalmology, Queen's Medical Centre, Nottingham, UK.
authors.forename: A R S
authors.initials: AR
authors.lastname: Sarhan
authors.forename: U
authors.initials: U
authors.lastname: Fares
authors.forename: M A
authors.initials: MA
authors.lastname: Al-Aqaba
authors.forename: A
authors.initials: A
authors.lastname: Miri
authors.forename: A M
authors.initials: AM
authors.lastname: Otri
authors.forename: D G
authors.initials: DG
authors.lastname: Said
authors.forename: H S
authors.initials: HS
authors.lastname: Dua
mesh_terms: D000328:Adult; D000368:Aged; D001251:Astigmatism / Q000209:etiology / Q000517:prevention & control*; D003315:Cornea / Q000473:pathology* / Q000601:surgery; D019781:Corneal Topography; D005260:Female; D006801:Humans; D015948:Keratoplasty, Penetrating / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013536:Suture Techniques