Effect of selective suture removal on graft astigmatism after corneal transplantation in keratoconus.

IF 2.3 Q2 OPHTHALMOLOGY Therapeutic Advances in Ophthalmology Pub Date : 2025-02-04 eCollection Date: 2025-01-01 DOI:10.1177/25158414241305498

Sepehr Feizi, Mohammad Ali Javadi, Zahra Karjou, Nasim Nouri, Maryam Oraeeyazdani, Zahra Khorrami, Hamed Esfandiari

{"title":"Effect of selective suture removal on graft astigmatism after corneal transplantation in keratoconus.","authors":"Sepehr Feizi, Mohammad Ali Javadi, Zahra Karjou, Nasim Nouri, Maryam Oraeeyazdani, Zahra Khorrami, Hamed Esfandiari","doi":"10.1177/25158414241305498","DOIUrl":null,"url":null,"abstract":"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.","PeriodicalId":23054,"journal":{"name":"Therapeutic Advances in Ophthalmology","volume":"17 ","pages":"25158414241305498"},"PeriodicalIF":2.3000,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11795613/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Therapeutic Advances in Ophthalmology","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1177/25158414241305498","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/1/1 0:00:00","PubModel":"eCollection","JCR":"Q2","JCRName":"OPHTHALMOLOGY","Score":null,"Total":0}

引用次数: 0

Abstract

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.

查看原文