Same-Day Removal Of All Sutures For The Management Of Post-Keratoplasty Astigmatism

Published 2024 - 42nd Congress of the ESCRS

Reference: PO758 | Type: Poster | DOI: 10.82333/mns5-7290

Authors: Abdulrahman Alfarhan* ¹ , Saeed Alshahrani ² , Saad H Alenezi ³

¹Anterior Segment Division,King Khaled Eye Specialist Hospital,Riyadh,Saudi Arabia, ²Department of Ophthalmology,King Abdulaziz Medical City, National Guard Health Affairs,Riyadh,Saudi Arabia, ³Ophthalmology Department, Faculty of Medicine,Majmaah University,Majmaah,Saudi Arabia

Purpose

Despite the integrity of the graft, post-keratoplasty astigmatism can adversely affect the visual acuity. Standard conventions limit one to two sutures to be removed per visit. This prolongs the visual rehabilitation period and increases the number of follow-up visits. This study evaluate the visual acuity and the magnitude of astigmatic changes as a result of removing all corneal sutures in the same sitting..

Setting

Data extracted from January 2016 to May 2020 at King Khaled Eye Specialist Hospital.

Methods

This comparative retrospective study enrolled keratoconus affected eyes that underwent deep anterior lamellar keratoplasty (DALK). Suturing technique consisting of a 16-bite interrupted 10-0 nylon sutures was used at the time of keratoplasty. In every clinic visit, patients had to be examined with Pentacam, refraction and visual acuity measurements were converted to logMAR for statistical analysis. Patient who had complete suture removal in the operating room were compared to patient who underwent selective-suture removal in the clinic.

Results

A total of 140 patients were included and subsequently monitored until removal of all sutures. Of which, sutures of 40 eyes were all removed at once. Mean patient age was 29.8 ± 7.4 years at the time of keratoplasty. The mean interval from surgery to complete suture removal was 20 ± 6 months. Compared with the pre-suture removal values, there was a signiﬁcant improvement in uncorrected visual acuity (UCVA) (0.63 ± 0.3 LogMAR, P = 0.018), with increased in the tomographic astigmatism (6.5 ± 4.1 D, P = 0.045). Refractive astigmatism showed no significant changes (-4.9 ± 1.9 D, P = 0.303). Despite subjective improvement in UCVA on Snellen chart, the mean spherical equivalent has increased by -2.6 diopter.

Conclusions

Complete removal of interrupted sutures resulted in an unexpected and substantial rise in both myopic refractive error and keratometric astigmatism measurements. This study also compared the effects of selective removal of interrupted sutures with a complete suture removal at once in a small cohort. Our results showed that delayed complete removal of all suture can yield a similar outcome to selective suture removal.