Serdarevic O N, Renard G J, Pouliquen Y
Department of Ophthalmology, Cornell University Medical College, New York.
Ophthalmology. 1994 Jun;101(6):990-9. doi: 10.1016/s0161-6420(94)31201-2.
The authors performed a prospective, randomized clinical trial to compare postoperative astigmatism and visual rehabilitation after penetrating keratoplasty with and without intraoperative suture adjustment.
Twenty-five patients undergoing penetrating keratoplasty for avascular corneal pathology randomly were assigned to two groups. All surgery was performed by one surgeon (ONS) using the same technique (except for intraoperative suture adjustment) with Hanna trephination (8 mm) and a running 10-0 nylon suture. Postoperative suture adjustment was done during the first postoperative month in all patients who had more than 3.5 diopters of astigmatism. Refraction and computerized topographic analysis were performed at 1 and 6 months postoperatively.
Intraoperative suture adjustment significantly decreased postkeratoplasty topographic (P = 0.0001) and refractive (P = 0.0001) astigmatism and improved best spectacle-corrected visual acuity (P = 0.0019) during the first postoperative month. Seventy-seven percent of control patients (mean topographic astigmatism, 4.89 +/- 1.99 D at 1 month), but no patients who underwent intraoperative suture adjustment (mean topographic astigmatism, 1.50 +/- 0.74 D at 1 month), required at least one postoperative suture adjustment that delayed optical stability and increased postoperative complications. At 6 months postoperatively, mean topographic (P = 0.06) and refractive (P = 0.0001) astigmatism were smaller in the intraoperatively adjusted group than in the control group with postoperative suture adjustments. After intraoperative adjustment, best spectacle-corrected visual acuity was better (P = 0.0168, P = 0.0434) and corneal topography was more regular (P = 0.02, P = 0.07, NS) at 1 and 6 months, respectively, than after postoperative adjustment.
Visual rehabilitation with decreased postkeratoplasty astigmatism and more regular corneal topography was attained more rapidly and safely with intraoperative suture adjustment.
作者进行了一项前瞻性随机临床试验，以比较穿透性角膜移植术中进行与不进行术中缝线调整后的术后散光和视力恢复情况。
25例因无血管性角膜病变接受穿透性角膜移植术的患者被随机分为两组。所有手术均由一名外科医生（ONS）采用相同技术（术中缝线调整除外），使用汉纳环钻（8毫米）和连续10-0尼龙缝线进行。术后第一个月，所有散光超过3.5屈光度的患者均进行了术后缝线调整。术后1个月和6个月进行验光和计算机化地形图分析。
术中缝线调整在术后第一个月显著降低了角膜移植术后的地形图散光（P = 0.0001）和屈光散光（P = 0.0001），并提高了最佳矫正视力（P = 0.0019）。77%的对照组患者（术后1个月平均地形图散光为4.89±1.99 D）需要至少一次术后缝线调整，这延迟了光学稳定性并增加了术后并发症，而术中进行缝线调整的患者无一例需要（术后1个月平均地形图散光为1.50±0.74 D）。术后6个月，术中调整组的平均地形图散光（P = 0.06）和屈光散光（P = 0.0001）均小于进行术后缝线调整的对照组。术中调整后，术后1个月和6个月的最佳矫正视力分别更好（P = 0.0168，P = 0.0434），角膜地形图更规则（P = 0.02，P = 0.07，无显著性差异）。
术中缝线调整能更快速、安全地实现角膜移植术后散光降低和角膜地形图更规则的视力恢复。
