Reconsidering Sequential Double Running Suture Removal After Penetrating Keratoplasty: A Prospective Randomized Study...

Area of Science:

• Ophthalmology
• Corneal Surgery
• Biomedical Engineering

Background:

• Penetrating keratoplasty (PK) is a common corneal transplantation procedure.
• Graft alignment and refractive stability are critical for successful outcomes.
• Suture removal is a key step influencing corneal curvature and astigmatism post-PK.

Purpose of the Study:

• To compare the impact of sequential double running suture removal on corneal curvature.
• To evaluate differences between excimer laser and mechanical trephination in PK.
• To assess the effect on post-operative astigmatism and graft alignment.

Main Methods:

• 134 patients undergoing PK were divided into excimer laser (n=60) and motor trephination (control, n=74) groups.
• All patients received a double running cross-stitch suture.
• Corneal curvature and topography were measured before and after sequential suture removal.

Main Results:

• The excimer laser group showed significantly smaller changes in corneal base curve and astigmatism post-suture removal compared to the control group.
• Astigmatism decreased or remained stable in 79% of excimer laser patients versus 20% of control patients.
• Vector-corrected astigmatism changes were significantly less in the excimer group.

Conclusions:

• Excimer laser trephination results in superior graft alignment and refractive stability after sequential suture removal in PK.
• Less change in corneal curvature and astigmatism indicates better outcomes with excimer laser use.
• This technique offers improved predictability for visual outcomes in penetrating keratoplasty.