Feizi Sepehr, Javadi Mohammad Ali, Behnaz Nazanin, Fani-Hanife Sadaf, Jafarinasab Mohammad Reza
Ophthalmic Research Center, Ophthalmology Department, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Cornea. 2018 Jan;37(1):39-44. doi: 10.1097/ICO.0000000000001443.
To evaluate the effect of suture removal on refraction and keratometry measurements after deep anterior lamellar keratoplasty (DALK).
This retrospective study enrolled 54 keratoconus-affected eyes that underwent DALK. A combined suturing technique consisting of a 16-bite single running and 8-bite interrupted 10-0 nylon sutures was used at the time of keratoplasty. Selective interrupted suture removal was performed in a subgroup of patients to reduce postkeratoplasty astigmatism. In another subgroup, all sutures were removed at a single session. Adjustment of the running suture tension was not performed in any case. The effect of suture removal on refractive outcomes was investigated in the entire study group, and the 2 subgroups were compared.
Mean patient age was 26.6 ± 6.7 years at the time of keratoplasty. The mean interval from surgery to complete suture removal was 17.4 ± 5.9 months. Compared with the pre-suture removal values, there was a significant increase in the magnitude of myopia (-1.12 ± 1.73 D, P = 0.001), refractive astigmatism (-0.89 ± 2.47 D, P = 0.04), mean keratometry (1.39 ± 1.64 D, P = 0.001), and keratometric astigmatism (2.61 ± 2.43 D, P < 0.001) after complete suture removal. Subgroup analysis revealed that selective removal of interrupted sutures was effective as long as remaining interrupted and running sutures were left in place.
Complete suture removal was followed by an unpredictable and significant increase in post-DALK refraction and keratometry readings. In the subgroup that underwent early selective removal of interrupted sutures before complete suture removal, the desirable effects of this procedure significantly diminished after all remaining sutures were completely removed.
评估深前板层角膜移植术（DALK）后拆线对屈光和角膜曲率测量的影响。
这项回顾性研究纳入了54只接受DALK的圆锥角膜患眼。角膜移植时采用了由16针单连续缝合和8针间断10-0尼龙缝线组成的联合缝合技术。在一个亚组患者中进行选择性间断拆线以减少角膜移植术后散光。在另一个亚组中，一次性拆除所有缝线。在任何情况下均未对连续缝线张力进行调整。在整个研究组中研究了拆线对屈光结果的影响，并对两个亚组进行了比较。
角膜移植时患者平均年龄为26.6±6.7岁。从手术到完全拆线的平均间隔时间为17.4±5.9个月。与拆线前的值相比，完全拆线后近视度数（-1.12±1.73 D，P = 0.001）、屈光性散光（-0.89±2.47 D，P = 0.04）、平均角膜曲率（1.39±1.64 D，P = 0.001）和角膜曲率性散光（2.61±2.43 D，P < 0.001）均有显著增加。亚组分析显示，只要保留剩余的间断缝线和连续缝线，选择性拆除间断缝线是有效的。
完全拆线后，DALK术后的屈光和角膜曲率读数出现了不可预测的显著增加。在完全拆线前早期选择性拆除间断缝线的亚组中，在所有剩余缝线完全拆除后，该手术的理想效果显著减弱。
