ESCRS - FP05.04 - THE EFFECT OF HOST RIM THICKNESS ON THE RESULTS OF SELECTIVE SUTURE REMOVAL DURING POST-OPERATIVE FOLLOW-UP OF PENETRATING KERATOPLASTY WITH LARGE GRAFT DIAMETERS

THE EFFECT OF HOST RIM THICKNESS ON THE RESULTS OF SELECTIVE SUTURE REMOVAL DURING POST-OPERATIVE FOLLOW-UP OF PENETRATING KERATOPLASTY WITH LARGE GRAFT DIAMETERS

Published 2025 - 29th ESCRS Winter Meeting

Reference: FP05.04 | Type: Free Paper | DOI: 10.82333/mxem-jf95

Authors: Barbaros Hayrettin Ünlü* 1 , Canan A. Utine 2

1Ophthalmology,Menemen State Hospital,İzmir,Türkiye, 2Ophthalmology,Dokuz Eylül University Hospital,İzmir,Türkiye

Purpose

The main goal of this study is to investigate the effect of host rim thickness on the efficacy of selective suture removal during postoperative follow-up of penetrating keratoplasty (PK), in patients with large graft diameters.

Setting

Dokuz Eylul University Hospital, Department of Ophthalmology, Cornea Division

Methods

A total of thirty-eight eyes of 38 patients with a graft diameter of 7.75mm and above were included in this study. The difference between the graft (punch) diameter and the trephine diameter was 0.25 mm in 28 patients, 0.50 mm in 9 patients, and 0.75 mm in 1 patient. All PK surgeries were performed with 16 interrupted 10/0 nylon sutures. During the postoperative follow-up, 2 sutures were removed at the outpatient clinics from steep semi-meridians for the management of astigmatism, when it was greater than 3.00 D. The manifest refractive cylinder values to obtain the best-corrected visual acuity (BCVA) were recorded before and 1 week after suture removal. The vectorial analysis program was used to examine the change in manifest astigmatism.

Results

The average age of the patients was 52.66±18.71 years, %58 were male, and %53 had surgery on the right eye. Selective suture removal was performed at an average of 4.30±1.71 (3 - 11) months postoperatively. Indications for PK were %31 pseudophakic bullous keratopathy, %18 keratoconus, %21 HSV keratitis, %16 corneal dystrophy, and %14 other etiologies. The BCVA was 0.20 preoperatively and 0.28 postoperatively in Snellen lines. The patients were divided into three groups according to rim thickness: <1.81 mm (=14), 1.81-2.11 mm (n=13), and >2.11 mm (n=11). The mean refractive astigmatism was +9.11±2.20 in group 1, +6.88±2.75 in group 2, and +8.24±2.97 in group 3 before suture removal; +5.71±2.51 in group 1, +5.60±2.67 in group 2, and +4.83±2.29 in group 3 at the 1st week after suture removal. The vectorial analysis revealed a decrease in astigmatism of 6.12±3.50 D in group 1, 6.52±5.05 D in group 2, and 4.87±2.33 D in group 3.

Conclusion

In this study, the astigmatism-reducing effect of selective suture removal decreased in patients who underwent large graft diameter during PK when the rim thickness exceeded 2.15 mm. Conversely, in cases with thin rim thickness, the effect of selective suture removal may be increased by reduced biomechanical resistance of the host bed.