Skip to main content
PMC home page
The British Journal of Ophthalmology logoLink to The British Journal of Ophthalmology
. 2000 Aug;84(8):837–841. doi: 10.1136/bjo.84.8.837

Effect of disagreement between refractive, keratometric, and topographic determination of astigmatic axis on suture removal after penetrating keratoplasty

A Sarhan 1, H Dua 1, M Beach 1
PMCID: PMC1723594  PMID: 10906087

Abstract

BACKGROUND/AIMS—Post-keratoplasty astigmatism can be managed by selective suture removal in the steep axis. Corneal topography, keratometry, and refraction are used to determine the steep axis for suture removal. However, often there is a disagreement between the topographically determined steep axis and sutures to be removed and that determined by keratometry and refraction. The purpose of this study was to evaluate any difference in the effect of suture removal, on visual acuity and astigmatism, in patients where such a disagreement existed.
METHODS—37 cases (from 37 patients) of selective suture removal after penetrating keratoplasty, were included. In the first group "the disagreement group" (n=15) there was disagreement between corneal topography, keratometry, and refraction regarding the axis of astigmatism and sutures to be removed. In the second group "the agreement group" (n=22) there was agreement between corneal topography, keratometry, and refraction in the determination of the astigmatic axis and sutures to be removed. Sutures were removed according to the corneal topography, at least 5 months postoperatively. Vector analysis for change in astigmatism and visual acuity after suture removal was compared between groups.
RESULTS—In the disagreement group, the amount of vector corrected change in refractive, keratometric, and topographic astigmatism after suture removal was 3.45 (SD 2.34), 3.57 (1.63), and 2.83 (1.68) dioptres, respectively. In the agreement group, the amount of vector corrected change in refractive, keratometric, and topographic astigmatism was 5.95 (3.52), 5.37 (3.29), and 4.71 (2.69) dioptres respectively. This difference in the vector corrected change in astigmatism between groups was statistically significant, p values of 0.02, 0.03, and 0.03 respectively. Visual acuity changes were more favourable in the agreement group. Improvement or no change in visual acuity occurred in 90.9% in the agreement group compared with 73.3% of the disagreement group.
CONCLUSIONS—Agreement between refraction, keratometry, and topography was associated with greater change in vector corrected astigmatism and was an indicator of good prognosis. Disagreement between refraction, keratometry, and topography was associated with less vector corrected change in astigmatism, a greater probability of decrease in visual acuity, and a relatively poor outcome following suture removal. However, patients in the disagreement group still have a greater chance of improvement than worsening, following suture removal.



Full Text

The Full Text of this article is available as a PDF (126.9 KB).

Figure 1  .

Figure 1  

Open in a new tab

Vector corrected change in astigmatism after suture removal in the two groups. There was a statistically significant increase in vector corrected change in astigmatism, measured by refraction, keratometry, and topography, following suture removal in the agreement group when compared with the disagreement group.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Artaria L. G. Computerisierte Hornhauttopographie in der Behandlung des hochgradigen Astigmatismus nach perforierender Keratoplastik. Klin Monbl Augenheilkd. 1995 May;206(5):312–316. [PubMed] [Google Scholar]
  2. Bertram B. A., Drews C., Gemmill M., Guell J., Murad M., Waring G. O. Inadequacy of a polyester (Mersilene) suture for the reduction of astigmatism after penetrating keratoplasty. Trans Am Ophthalmol Soc. 1990;88:237–254. [PMC free article] [PubMed] [Google Scholar]
  3. Binder P. S. Selective suture removal can reduce postkeratoplasty astigmatism. Ophthalmology. 1985 Oct;92(10):1412–1416. doi: 10.1016/s0161-6420(85)33856-3. [DOI] [PubMed] [Google Scholar]
  4. Binder P. S. The effect of suture removal on postkeratoplasty astigmatism. Am J Ophthalmol. 1988 Jun 15;105(6):637–645. doi: 10.1016/0002-9394(88)90057-8. [DOI] [PubMed] [Google Scholar]
  5. Cohen K. L., Holman R. E., Tripoli N. K., Kupper L. L. Effect of trephine tilt on corneal button dimensions. Am J Ophthalmol. 1986 Jun 15;101(6):722–725. doi: 10.1016/0002-9394(86)90777-4. [DOI] [PubMed] [Google Scholar]
  6. Frangieh G. T., Kwitko S., McDonnell P. J. Prospective corneal topographic analysis in surgery for postkeratoplasty astigmatism. Arch Ophthalmol. 1991 Apr;109(4):506–510. doi: 10.1001/archopht.1991.01080040074030. [DOI] [PubMed] [Google Scholar]
  7. Gimbel H. V., Raanan M. G., DeLuca M. Effect of suture material on postoperative astigmatism. J Cataract Refract Surg. 1992 Jan;18(1):42–50. doi: 10.1016/s0886-3350(13)80382-3. [DOI] [PubMed] [Google Scholar]
  8. Girard L. J., Eguez I., Esnaola N., Barnett L., Maghraby A. Effect of penetrating keratoplasty using grafts of various sizes on keratoconic myopia and astigmatism. J Cataract Refract Surg. 1988 Sep;14(5):541–547. doi: 10.1016/s0886-3350(88)80013-0. [DOI] [PubMed] [Google Scholar]
  9. Girard L. J., Esnaola N., Rao R., Barnett L., Rand W. J. Use of grafts smaller than the opening for keratoconic myopia and astigmatism. A prospective study. J Cataract Refract Surg. 1992 Jul;18(4):380–384. doi: 10.1016/s0886-3350(13)80076-4. [DOI] [PubMed] [Google Scholar]
  10. Harris D. J., Jr, Waring G. O., 3rd, Burk L. L. Keratography as a guide to selective suture removal for the reduction of astigmatism after penetrating keratoplasty. Ophthalmology. 1989 Nov;96(11):1597–1607. doi: 10.1016/s0161-6420(89)32679-0. [DOI] [PubMed] [Google Scholar]
  11. Karabatsas C. H., Cook S. D., Sparrow J. M. Proposed classification for topographic patterns seen after penetrating keratoplasty. Br J Ophthalmol. 1999 Apr;83(4):403–409. doi: 10.1136/bjo.83.4.403. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Krumeich J., Binder P. S., Knulle A. The theoretical effect of trephine tilt on postkeratoplasty astigmatism. CLAO J. 1988 Oct-Dec;14(4):213–219. [PubMed] [Google Scholar]
  13. Mader T. H., Yuan R., Lynn M. J., Stulting R. D., Wilson L. A., Waring G. O., 3rd Changes in keratometric astigmatism after suture removal more than one year after penetrating keratoplasty. Ophthalmology. 1993 Jan;100(1):119–127. doi: 10.1016/s0161-6420(93)31705-7. [DOI] [PubMed] [Google Scholar]
  14. Maguire L. J., Bourne W. M. Corneal topography of transverse keratotomies for astigmatism after penetrating keratoplasty. Am J Ophthalmol. 1989 Apr 15;107(4):323–330. doi: 10.1016/0002-9394(89)90653-3. [DOI] [PubMed] [Google Scholar]
  15. Mahjoub S. B., Au Y. K. Astigmatism and tissue-shape disparity in penetrating keratoplasty. Ophthalmic Surg. 1990 Mar;21(3):187–190. [PubMed] [Google Scholar]
  16. Musch D. C., Meyer R. F., Sugar A., Soong H. K. Corneal astigmatism after penetrating keratoplasty. The role of suture technique. Ophthalmology. 1989 May;96(5):698–703. doi: 10.1016/s0161-6420(89)32848-x. [DOI] [PubMed] [Google Scholar]
  17. Nabors G., Vander Zwaag R., Van Meter W. S., Wood T. O. Suture adjustment for postkeratoplasty astigmatism. J Cataract Refract Surg. 1991 Sep;17(5):547–550. [PubMed] [Google Scholar]
  18. Olson R. J. Prevention of astigmatism in corneal transplant surgery. Int Ophthalmol Clin. 1988 Spring;28(1):37–45. doi: 10.1097/00004397-198802810-00006. [DOI] [PubMed] [Google Scholar]
  19. Olson R. J. The effect of scleral fixation ring placement and trephine tilting on keratoplasty wound size and donor shape. Ophthalmic Surg. 1981 Jan;12(1):23–26. [PubMed] [Google Scholar]
  20. Strelow S., Cohen E. J., Leavitt K. G., Laibson P. R. Corneal topography for selective suture removal after penetrating keratoplasty. Am J Ophthalmol. 1991 Dec 15;112(6):657–665. doi: 10.1016/s0002-9394(14)77271-x. [DOI] [PubMed] [Google Scholar]
  21. Van Meter W. S., Gussler J. R., Soloman K. D., Wood T. O. Postkeratoplasty astigmatism control. Single continuous suture adjustment versus selective interrupted suture removal. Ophthalmology. 1991 Feb;98(2):177–183. [PubMed] [Google Scholar]
  22. Villacriz E., Rife L., Smith R. E. Oval host wounds and postkeratoplasty astigmatism. Cornea. 1987;6(3):181–184. doi: 10.1097/00003226-198706030-00005. [DOI] [PubMed] [Google Scholar]
  23. van Rij G., Cornell F. M., Waring G. O., 3rd, Wilson L. A., Beekhuis W. H. Postoperative astigmatism after central vs eccentric penetrating keratoplasties. Am J Ophthalmol. 1985 Mar 15;99(3):317–320. doi: 10.1016/0002-9394(85)90362-9. [DOI] [PubMed] [Google Scholar]

Articles from The British Journal of Ophthalmology are provided here courtesy of BMJ Publishing Group

RESOURCES