LONG-TERM FOLLOW-UP OF A SINGLE CONTINUOUS ADJUSTABLE SUTURE IN PENETRATING KERATOPLASTY

Penetrating keratoplasty was performed on 30 patients using a single a djustable continuous 10/0 nylon suture. Seventeen patients had astigma tism of 4.00 dioptre cylinders (DC) or more and were adjusted. The lat est adjustment was at 32 weeks. Following adjustment there was a signi ficant reduction in median postkeratoplasty astigmatism from 6.00 DC t o 2.50 DC (p < 0.001). Thirteen patients, with astigmatism of 4.00 DC or less, were not adjusted. Median astigmatism for the non-adjusted gr oup was 3.00 DC and for the entire group was 2.88 DC. Long-term refrac tion and suture status were monitored with time. Mean follow-up was 11 2 weeks (range 53-170 weeks). Over the study period the entire group s howed significant 'long-term astigmatic drift' (LTAD), from 2.88 DC to 3.25 DC (median drift, 1.25 DC; range, 0.006.50 DC) (p < 0.001). Sutu re adjustment and suture removal showed no significant effect on LTAD. With suture removal between 32 and 84 weeks median LTAD was 1.50 DC. For suture removal after 84 weeks, median LTAD was also 1.50 DC, but t he range of LTAD was 1.50 DC, compared with a larger range of 5.00 DC in the earlier suture removal group. The technique of single continuou s adjustable sutures for penetrating keratoplasty is safe, effective i n reducing astigmatism, but may need modification to further enhance l ong-term refractive stability.