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

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 visual rehabilitation and the number of follow-up visits. This study evaluates the visual acuity and magnitude of astigmatic changes as a result of removing all corneal sutures in the same sitting.

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

This comparative retrospective study enrolled patients with keratoconus who underwent deep anterior lamellar keratoplasty (DALK) from January 2016 to May 2020. Suturing technique consisting of a 16-bite interrupted 10-0 nylon sutures was used at the time of keratoplasty. In every clinic visit, patients underwent corneal topography, refraction and visual acuity measurements. Patients who had complete suture removal in the operating room were compared to patients who underwent selective-suture removal in the clinic.

A total of 143 patients were included and subsequently monitored until removal of all sutures. In 39 eyes sutures were all removed at one sitting. The mean age of the study sample 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 to pre-suture removal values, there was a significant improvement in uncorrected visual acuity (UCVA) (0.63 .3 LogMAR, P=0.018), with increased 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 with theSnellen chart, the mean spherical equivalent increased by -2.6 D. 

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