Dolorico Arlene M T, Tayyani Ramin, Ong Hung V, Gaster Ronald N
Department of Ophthalmology, University of California, Irvine, and Long Beach VA Medical Center, USA.
J Am Coll Surg. 2003 Dec;197(6):991-9. doi: 10.1016/j.jamcollsurg.2003.07.016.
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.
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.
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).
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.
在眼科手术中，当角膜因瘢痕、水肿和角膜厚度不均等情况而透明度显著受损时，可能会采用角膜移植术（穿透性角膜移植术）。术后可能会出现角膜曲率不规则的情况。这种散光令人担忧，因为尽管手术结果在其他方面良好，但它仍会损害视力。人们已开发出不同的缝合技术以尽量减少散光。本研究的目的是评估一种用于穿透性角膜移植术的相对的10-0尼龙双连续缝合技术。
对一位外科医生（RNG）进行的91例穿透性角膜移植术患者的记录进行了回顾性研究。这占连续166例病例的54.8%。选择每只采用相对双连续缝合且在缝线拆除后1至3个月进行随访的眼睛，评估其最佳矫正视力和散光情况，排除发生移植失败、角膜溃疡或随访不足的眼睛。根据术前诊断将病例分为五组：人工晶状体眼大泡性角膜病变（n = 43）、无晶状体眼大泡性角膜病变（n = 5）、圆锥角膜（n = 17）、富克斯营养不良（n = 12）和其他（n = 14）。穿透性角膜移植术后的平均标准随访期为13.7个月。30%的眼睛进行了广泛随访，穿透性角膜移植术后平均随访33个月。
82%的患者术后视力有显著改善，定义为最佳矫正视力提高五行或最佳矫正视力达到20/40或更好。在缝线拆除后1至3个月的随访中，平均角膜散光读数为3.98屈光度，明显屈光柱镜为3.42屈光度。本研究还表明，从缝线拆除后1至三个月的测量到穿透性角膜移植术后18至66个月的更广泛随访，角膜散光或明显屈光柱镜没有统计学上的显著变化（p > 0.10）。
这种缝合技术可使伤口具有出色的长期稳定性，其视力和散光结果与先前研究相当。使用相对双连续缝合是一些其他广泛使用技术的可行替代方法，可能被认为更稳定、更可靠。
