Management of post-keratoplasty astigmatism

Fares, Usama; Sarhan, A R Sebai; Dua, Harminder S.

doi:10.1016/j.jcrs.2012.09.002

Cited by 81 publications

(90 citation statements)

References 106 publications

(111 reference statements)

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“…This includes donor and recipient factors such as trephination, graft-host size disparity, wound healing and apposition, suturing technique, and suture material. 1 Different techniques are described to secure the grafthost junction. This includes double or single running sutures, interrupted sutures, and combined running and interrupted sutures.…”

Section: Discussionmentioning

confidence: 99%

“…This can be extended to three or four sutures in steep semimeridians. 1,2,12 The rationale for this is that the effect of suture removal on the astigmatism is not instant both in terms of magnitude and vector, and a reassessment for residual astigmatism and axis was therefore undertaken between 3 and 6 weeks after removal of one pair (or four Figure 2 Refractive astigmatism before and after suture removal (dioptres), plotted as an astigmatic vector for each eye.…”

Section: Discussionmentioning

confidence: 99%

“…1,2,8 When suture removal is commenced in the early post-operative period there is an additional risk of wound dehiscence if adjacent sutures are removed, especially in the elderly who would also be on topical steroids, which are known to delay wound healing. 1 Furthermore, it has been shown that removing a single suture was more efficient and predictable than removing multiple sutures at one time.…”

Section: Discussionmentioning

confidence: 99%

“…A number of different techniques have been described to address moderateto-high astigmatism following corneal transplantation. 1 Suture manipulation is usually considered to be the first step in managing postkeratoplasty astigmatism, while the sutures are still present. This may include selective suture removal in the case of eyes with interrupted/ mixed sutures 2 or suture adjustment in the case of eyes with running sutures.…”

Section: Introductionmentioning

confidence: 99%

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Sequential selective same-day suture removal in the management of post-keratoplasty astigmatism

Fares

Mokashi

El‐Alfy

et al. 2013

Eye

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Aims In a previous study, we proposed that corneal topography performed 30-40 min after the initial suture removal can identify the next set of sutures requiring removal, for the treatment of post-keratoplasty astigmatism. The aim of this study was to evaluate the effect of removing subsequent sets of sutures at the same sitting. Methods 10/0 nylon interrupted sutures were placed, to secure the graft-host junction, at the time of keratoplasty. Topography was performed using Pentacam (Oculus) before suture removal. The sutures to be removed in the steep semi-meridians were identified and removed at the slit-lamp biomicroscope. Topography was repeated 30-40 min post suture removal, the new steep semi-meridians determined, and the next set of sutures to be removed were identified and removed accordingly. Topography was repeated 4-6 weeks later and the magnitude of topographic astigmatism was recorded. A paired-samples t-test was used to evaluate the impact of selective suture removal on reducing the magnitude of topographic and refractive astigmatism. Results Twenty eyes of 20 patients underwent sequential selective same-day suture removal (SSSS) after corneal transplantation. This study showed that the topographic astigmatism decreased by about 46.7% (3.68 D) and the refractive astigmatism decreased by about 37.7% (2.61 D) following SSSS. Vector calculations also show a significant reduction of both topographic and refractive astigmatism (Po0.001). Conclusion SSSS may help patients to achieve satisfactory vision more quickly and reduce the number of follow-up visits required post keratoplasty.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Sequential selective same-day suture removal in the management of post-keratoplasty astigmatism

Fares

Mokashi

El‐Alfy

et al. 2013

Eye

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“…[2][3][4][5] In recent studies, mean postoperative topographic astigmatism exceeding 6 diopters (D) has been reported in patients undergone PK. 6,7 Factors influencing the amount of astigmatism include the severity of underlying disorder (eg keratoconus), oval or eccentric trephination, graft size, donor recipient disparity, corneal thickness mismatch between donor and the recipient, a poor suturing technique and time of suture removal or adjustment.…”

mentioning

confidence: 99%

Topographic Changes After Suture Removal in Patients with Penetrating Keratoplasty

Yüksel¹,

Uzunel²,

Aydin³

et al. 2017

Turkiye Klinikleri J Ophthalmol

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A AB BS S T TR RA AC CT T O Ob bj je ec ct ti iv ve e: : To investigate the changes in topographic parameters after suture removal in patients with penetrating keratoplasty (PK) and to assess the predictability of these changes. M Ma at te er ri ia al l a an nd d M Me et th ho od ds s: : This prospective study included 88 eyes of 88 corneal graft patients. Fifty-one were male and 37 female. Mean age was 52.5±18.3 years. Main indications were keratoconus (23) and bullous keratopathy (18). Donor corneas were cut from the endothelial side with a disposable donor punch and sutured into the recipient bed with single 10-0 nylon running suture. Sutures were removed at 1 year. Corneal topographies were acquired with Keratograph (Oculus, Wetzlar, Germany) immediately before and one month after suture removal. . Ecc value decreased from 0.48 to 0.11 (p=0.000). Analyzed area increased from 36.90 to 41.44% (p= 0.012). Prolate topographic patterns decreased from 42.0% to 36.4%, oblate patterns increased from 26.1% to 39.8% after suture removal. C Co on nc cl lu us si io on n: : Mean K value increased 2.3 D after suture removal, meaning a myopic shift in refraction. Topographic analysis can be acquired in a wider area. Overall oblate and ellipsoid geometry of the cornea, determined by the Q and Ecc values, remains the same after suture removal.K Ke ey yw wo or rd ds s: : Keratoplasty, penetrating; corneal topography Ö ÖZ ZE ET T A Am ma aç ç: : Penetran keratoplastili (PK) hastalarda sütür alımı sonrası topografik parametrelerdeki değişimleri incelemek ve bu değişikliklerin öngörülebilirliğini değerlendirmek. G Ge er re eç ç v ve e Y Yö ön nt te em m--l le er r: : Bu prospektif çalışma 88 korneal greft hastasının 88 gözünü içermektedir. Bu hastaların 51'i erkek ve 37'si kadındı. Ortalama yaş 52.5 ± 18.3 yıldı. Başlıca endikasyonlar keratokonus (23) ve bül-löz keratopati (18) idi. Donör kornealar tek kullanımlık donör punch ile endotel yüzünden kesildi ve alıcı yatağa 10-0 naylon sütür ile kontinü olarak sütüre edildi. Sütürler 1. yılda alındı. Korneal topografiler Keratograph (Oculus, Wetzlar, Germany) ile sütür alımından hemen önce ve 1 ay sonra yapıldı. En düz ve en dik keratometri (K) değerleri (Diyoptri: D), astigmatizmanın gücü ve aksı, ekzantrisite (Ecc), Q değeri, analize edilen bölge, topografik paternler kaydedildi. B Bu ul lg gu ul la ar r: : Sütür alımından sonra ortalama K değeri 42,18±4,97 (30,65-53,20) D'den 44,46±4,10 (29,45-55,20) D'ye (p=0,001), ortalama astigmatizma 4,66 D'den 5,68 D'ye yükseldi (p=0,017). Ecc değeri 0,48'den 0,11'ye düştü (p˂0,001). Analize edilen alan %36,90'dan %41.44'e yükseldi (p=0,012). Sütür alımı sonrası prolat topografik paternler %42.0'den %36,4'e düşerken, oblat paternler %26,1'den %39,8'e yükseldi. S So on nu uç ç: : Ortalama K değeri sütür alımı sonrası 2,3 D arttı, bu refraksiyonda miyopik değişim demekti. Topografik analiz daha geniş bir alanda elde edilebilmektedir. Korneanın Q ve ekzantrisite değerlerinin gösterdiği oblat ve elipsoid geometri, sütür alımı sonrasında da deği...

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Postkeratoplasty Astigmatism Treatment with a Combination of Intrastromal Corneal Ring Segment Implantation and Photorefractive Keratectomy

Bertino

Magalhães²,

Júnior

2022

Keratoconus

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Management of post-keratoplasty astigmatism

Abstract: No author has a financial or proprietary interest in any material or method mentioned.

Cited by 81 publications

References 106 publications

Sequential selective same-day suture removal in the management of post-keratoplasty astigmatism

Sequential selective same-day suture removal in the management of post-keratoplasty astigmatism

Topographic Changes After Suture Removal in Patients with Penetrating Keratoplasty

Postkeratoplasty Astigmatism Treatment with a Combination of Intrastromal Corneal Ring Segment Implantation and Photorefractive Keratectomy

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