Purse-string sutures for hyperopia following radial keratotomy

Five years ago, we presented 19 procedures employing two intrastromal purse-string sutures to treat hyperopic shift following radial keratotomy. Thirty-four additional procedures and longer follow-up are now presented detailing the task of rehabilitating these eyes.

Fifty-three eyes of 53 radial keratotomy patients who were unhappy with their uncorrected vision and who were dissatisfied with contact lens or spectacle correction underwent double corneal intrastromal purse-string suturing and were subsequently followed for at least 1 year. There were seven eyes with primary overcorrection and 46 eyes with progressive hyperopic shift. Spherical equivalent refraction before purse-string sutures ranged from +0.50 to +6.25 D (mean, +2.60 D, SD +/- 1.26 D). Prior to purse-string suturing, uncorrected visual acuity ranged from 20/30 to 20/400 with 21 eyes (45.3%) 20/100 or worse.

The follow-up after suturing averaged 3.6 years (range, 1 to 10 yr). All patients had follow-up of at least 1 year. The steepening in average keratometric power was 2.94 +/- 1.72 D (range, 1.06 to 6.68 D). The sherical equivalent refraction after suturing averaged -0.15 +/- 1.17 D (range, +3.75 to -2.50 D). Uncorrected visual acuity after suturing was 20/40 or better in 38 eyes (72%) and 20/50 to 20/100 in 15 eyes (28%). The number of eyes with a spherical equivalent refraction of +/- 0.50 D with 0.50 D or less refractive astigmatism was 15 (26% of eyes). There were 34 eyes (66%) with +/- 1.00 D with 1.00 D or less of refractive astigmatism, and 42 eyes (78%) with +/- 2.00 D with 2.00 D or less refractive astigmatism. Most of the spread was on the myopic side, as intended. There were no significant intraoperative or postoperative complications. Fifteen eyes gained two or more lines of best spectacle-corrected visual acuity and no eyes lost one line.

Double intrastromal purse-string suturing produces steepening of the central cornea and reduces hyperopia after radial keratotomy.