title: Sequential selective same-day suture removal in the management of post-keratoplasty astigmatism.
abstract: OBJECTIVE
  In a previous study, we proposed that corneal topography performed 30-40 min after the initial suture removal can identify the next set of sutures requiring removal, for the treatment of post-keratoplasty astigmatism. The aim of this study was to evaluate the effect of removing subsequent sets of sutures at the same sitting.
  
  
  METHODS
  10/0 nylon interrupted sutures were placed, to secure the graft-host junction, at the time of keratoplasty. Topography was performed using Pentacam (Oculus) before suture removal. The sutures to be removed in the steep semi-meridians were identified and removed at the slit-lamp biomicroscope. Topography was repeated 30-40 min post suture removal, the new steep semi-meridians determined, and the next set of sutures to be removed were identified and removed accordingly. Topography was repeated 4-6 weeks later and the magnitude of topographic astigmatism was recorded. A paired-samples t-test was used to evaluate the impact of selective suture removal on reducing the magnitude of topographic and refractive astigmatism.
  
  
  RESULTS
  Twenty eyes of 20 patients underwent sequential selective same-day suture removal (SSSS) after corneal transplantation. This study showed that the topographic astigmatism decreased by about 46.7% (3.68 D) and the refractive astigmatism decreased by about 37.7% (2.61 D) following SSSS. Vector calculations also show a significant reduction of both topographic and refractive astigmatism (P<0.001).
  
  
  CONCLUSIONS
  SSSS may help patients to achieve satisfactory vision more quickly and reduce the number of follow-up visits required post keratoplasty.
authors.affiliation: 1] Division of Ophthalmology and Visual Sciences, University of Nottingham, Nottingham, UK [2] Division of Ophthalmology and Visual Sciences, Nottingham University Hospitals, Queen's Medical Centre, Nottingham, UK.
authors.forename: U
authors.initials: U
authors.lastname: Fares
authors.forename: A A
authors.initials: AA
authors.lastname: Mokashi
authors.forename: M S
authors.initials: MS
authors.lastname: Elalfy
authors.forename: H S
authors.initials: HS
authors.lastname: Dua
mesh_terms: D000328:Adult; D001251:Astigmatism / Q000209:etiology / Q000517:prevention & control*; D003315:Cornea / Q000502:physiology / Q000601:surgery; D019781:Corneal Topography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015948:Keratoplasty, Penetrating / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D012029:Refraction, Ocular; D013536:Suture Techniques; D014792:Visual Acuity; D055815:Young Adult