Timing of Suture Removal in Sequential Surgery: A Pilot Study

Abstract

To study the appropriate timing of corneal suture removal in sequential surgery (penetrating keratoplasty [PK]-phacoemulsification [PE]) procedures. In a pilot study, patients with a PK double running suture in place requiring cataract surgery were randomized to suture removal 1 month before PE or during PE (n = 14; 7 in each group). Visual acuity, refraction, manual keratometry, Pentacam analysis, biomicroscopy, biometry, endothelial cell count, and funduscopy were determined before suture removal/PE and after PE (except biometry). Outcome measures at 6 months were corneal refractive change (induced by PE plus suture removal) analyzed by conversion to corneal power vector, index of surface variance change, and postoperative spherical equivalent, corrected, and uncorrected visual acuity. Average corneal refractive change induced was 1.63, -2.98 x 96 degrees in the preoperative suture removal group and 2.14, -2.84 x 90 degrees in the intraoperative suture removal group. Difference in parameters of the corneal power vector change were statistically significant but not clinically relevant (M, spherical component, 0.14 vs 0.72, P = 0.01, respectively; J, astigmatic component, 1.49 vs 1.42, P = 0.01, respectively). Postoperative spherical equivalent, index of surface variance change, and corrected and uncorrected visual acuity were not significantly different in the two groups. Differences in refractive state and visual acuity of the eye are not observed between patients with PK continuous suture removal (1 month) before PE and during PE.