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Published on: October 21, 2022
Effect of selective suture removal on graft astigmatism after corneal transplantation in keratoconus
Sepehr Feizi1, Mohammad Ali Javadi2, Zahra Karjou2
1Ocular Tissue Engineering Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, No. 23, Paidarfard Street, Boostan 9 Street, Pasdaran Avenue, Tehran 16666, Iran.
Background:
Selective suture removal has been demonstrated to be effective in reducing post-keratoplasty astigmatism, while the remaining sutures are left in place. Existing studies typically focus on outcomes immediately after selective suture removal, without delving into the final suture-out keratometric astigmatism.
Objectives:
To examine the impact of selective suture removal on corneal graft astigmatism following keratoplasty in keratoconus and identify potential factors associated with the changes in graft astigmatism after suture removal.
Design:
Retrospective, comparative interventional case series.
Methods:
The study included 118 consecutive eyes of 118 cases that underwent corneal transplantation for keratoconus and had a keratometric astigmatism of ⩾4 D. One or two interrupted sutures corresponding to the steep meridian were removed per session. Patients were re-evaluated at 1 to 2-month intervals, repeating the procedure until achieving a keratometric astigmatism of <4.0 D or no interrupted sutures remained in the steep meridian.
Results:
The mean recipient age was 28.4 ± 8.4 years. A total of 234 selective suture removals were performed, with a mean of 2.0 ± 1.1 removals per eye. Pre-suture removal keratometric astigmatism significantly decreased from 6.3 ± 2.0 D to 3.91 ± 2.23 D after the completion of selective suture removal (p < 0.001). This value was significantly increased to 5.45 ± 2.93 D after all suture removal (p < 0.001). Higher pre-suture removal astigmatism and deep anterior lamellar keratoplasty were associated with a more favorable response to selective suture removal.
Conclusion:
Selective suture removal effectively modifies graft curvature to reduce post-keratoplasty astigmatism in keratoconus patients. However, its efficacy markedly diminishes after all sutures are removed. This procedure is particularly effective in patients with higher pre-suture removal astigmatism and those undergoing deep anterior lamellar keratoplasty.
