Mader T H, Yuan R, Lynn M J, Stulting R D, Wilson L A, Waring G O
Emory University School of Medicine, Atlanta, GA.
Ophthalmology. 1993 Jan;100(1):119-26; discussion 127. doi: 10.1016/s0161-6420(93)31705-7.
BACKGROUND/PURPOSE: Selective removal of interrupted sutures and adjustment of a running suture can minimize astigmatism after penetrating keratoplasty, but the long-term effects of early suture manipulations remain largely unknown. The authors tested the hypothesis that the cornea becomes "fixed" more than 1 year after keratoplasty so that desirable refractive results will remain when all sutures are eventually removed.
The authors reviewed retrospectively the changes in astigmatism that occurred when all remaining sutures were removed from 162 eyes 1 to 6 years after penetrating keratoplasty. Single-running sutures were used in 130 eyes, double-running sutures in 20 eyes, and a combination of interrupted and running sutures in 12 eyes.
Removal of single-running sutures caused an average decrease in astigmatism of 0.52 diopters (D) from 6.10 +/- 4.41 D to 5.57 +/- 3.14 D. However, the astigmatism in 62% of eyes changed 2 or more D (range, 11.94 to -17.87 D), and the range changed more than 20 degrees in 55% of eyes. The average vectorial change was 6.5 +/- 4.3 D (range, 0.59 to 19.8 D). There was no decrease in the amount of astigmatic change with increasing time between surgery and suture removal. Graft size and diagnosis had no effect on the amount of astigmatic change. Astigmatic errors became stable, with less than 1 D of change between successive examinations within 6 months after suture removal. Similar results were obtained for eyes with double-running and interrupted-running sutures.
Corneal astigmatism may change unpredictably and by large amounts when all remaining sutures are removed 1 to 6 years after penetrating keratoplasty.
背景/目的：选择性拆除间断缝线并调整连续缝线可使穿透性角膜移植术后的散光最小化，但早期缝线操作的长期效果仍 largely 未知。作者检验了这样一个假设，即角膜在角膜移植术后 1 年以上会“固定”，因此当最终拆除所有缝线时，会保持理想的屈光结果。
作者回顾性分析了 162 只眼在穿透性角膜移植术后 1 至 6 年拆除所有剩余缝线时散光的变化情况。130 只眼使用单连续缝线，20 只眼使用双连续缝线，12 只眼使用间断缝线与连续缝线的组合。
拆除单连续缝线后，散光平均降低 0.52 屈光度（D），从 6.10±4.41 D 降至 5.57±3.14 D。然而，62%的眼散光变化 2 D 或更多（范围为 11.94 至 -17.87 D），55%的眼角膜散光轴向变化超过 20 度。平均矢量变化为 6.5±4.3 D（范围为 0.59 至 19.8 D）。手术与缝线拆除之间的时间增加，散光变化量并未减少。植片大小和诊断对散光变化量无影响。缝线拆除后 6 个月内，连续检查之间散光误差稳定，变化小于 1 D。双连续缝线和间断连续缝线的眼也得到了类似结果。
穿透性角膜移植术后 1 至 6 年拆除所有剩余缝线时，角膜散光可能会发生不可预测的大幅变化。
