Journal of the American College of Surgeons · 2003
Shortterm and longterm visual and astigmatic results of an opposing 10-0 nylon double running suture technique for penetrating keratoplasty.
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Dolorico Arlene M T, Tayyani Ramin, Ong Hung V, Gaster Ronald N
Аннотация
BACKGROUND: In ophthalmic surgery, corneal transplantation (penetrating keratoplasty) may be employed when the clarity of the cornea has been significantly compromised by conditions such as scarring, edema, and variable corneal thickness. Irregularities in corneal curvature can occur postoperatively. This astigmatism is of concern, because it can impair visual acuity despite an otherwise good surgical result. Different suturing techniques have been developed to minimize astigmatism. The purpose of this study was to evaluate an opposing 10-0 nylon double running suture technique for penetrating keratoplasty.
STUDY DESIGN: A retrospective study was undertaken of 91 records of patients who underwent penetrating keratoplasty performed by one surgeon (RNG). This represents 54.8% of 166 consecutive cases. Every eye with an opposing double running suture and a 1- to 3-month postsuture removal followup was selected and evaluated for best corrected visual acuity and astigmatism, excluding eyes that developed graft failure or corneal ulcer or that had lack of adequate followup. The cases were divided into five groups by preoperative diagnosis: pseudophakic bullous keratopathy (n = 43), aphakic bullous keratopathy (n = 5), keratoconus (n = 17), Fuchs dystrophy (n = 12), and miscellaneous (n = 14). The mean standard followup period was 13.7 months after penetrating keratoplasty. Thirty percent of the eyes had an extensive followup, with a mean of 33 months after penetrating keratoplasty.
RESULTS: Eighty-two percent of the patients had a significant improvement of their visual acuity postoperatively, defined by a five-line improvement of best corrected visual acuity or a best corrected visual acuity of 20/40 or better. The mean astigmatic keratometric reading was 3.98 diopters, with a manifest refraction cylinder of 3.42 diopters at the 1- to 3-month postsuture removal visit. This study also shows that there is no statistically significant change in keratometric astigmatism or manifest refraction cylinder from the 1- to 3-month postsuture removal measurements to the more extensive followup of 18 to 66 months after penetrating keratoplasty (p > 0.10).
CONCLUSIONS: This suture technique allows for excellent longterm stability of the wound with visual and astigmatic results that are comparable to those of previous studies. The use of the opposing double running suture is a viable alternative to some of the other widely used techniques and may be considered more stable and secure.
STUDY DESIGN: A retrospective study was undertaken of 91 records of patients who underwent penetrating keratoplasty performed by one surgeon (RNG). This represents 54.8% of 166 consecutive cases. Every eye with an opposing double running suture and a 1- to 3-month postsuture removal followup was selected and evaluated for best corrected visual acuity and astigmatism, excluding eyes that developed graft failure or corneal ulcer or that had lack of adequate followup. The cases were divided into five groups by preoperative diagnosis: pseudophakic bullous keratopathy (n = 43), aphakic bullous keratopathy (n = 5), keratoconus (n = 17), Fuchs dystrophy (n = 12), and miscellaneous (n = 14). The mean standard followup period was 13.7 months after penetrating keratoplasty. Thirty percent of the eyes had an extensive followup, with a mean of 33 months after penetrating keratoplasty.
RESULTS: Eighty-two percent of the patients had a significant improvement of their visual acuity postoperatively, defined by a five-line improvement of best corrected visual acuity or a best corrected visual acuity of 20/40 or better. The mean astigmatic keratometric reading was 3.98 diopters, with a manifest refraction cylinder of 3.42 diopters at the 1- to 3-month postsuture removal visit. This study also shows that there is no statistically significant change in keratometric astigmatism or manifest refraction cylinder from the 1- to 3-month postsuture removal measurements to the more extensive followup of 18 to 66 months after penetrating keratoplasty (p > 0.10).
CONCLUSIONS: This suture technique allows for excellent longterm stability of the wound with visual and astigmatic results that are comparable to those of previous studies. The use of the opposing double running suture is a viable alternative to some of the other widely used techniques and may be considered more stable and secure.