Rapid suture management of post-keratoplasty astigmatism.
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.
Sarhan
A R S
AR
Department of Ophthalmology, Queen's Medical Centre, Nottingham, UK.
Fares
U
U
Al-Aqaba
M A
MA
Miri
A
A
Otri
A M
AM
Said
D G
DG
Dua
H S
HS
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