RANDOMIZED CLINICAL-TRIAL COMPARING ASTIGMATISM AND VISUAL REHABILITATION AFTER PENETRATING KERATOPLASTY WITH AND WITHOUT INTRAOPERATIVE SUTURE ADJUSTMENT

Purpose: The authors performed a prospective, randomized clinical tria l to compare postoperative astigmatism and visual rehabilitation after penetrating keratoplasty with and without intraoperative suture adjus tment. Methods: Twenty-five patients undergoing penetrating keratoplas ty for avascular corneal pathology randomly were assigned to two group s. All surgery was performed by one surgeon (ONS) using the same techn ique (except for intraoperative suture adjustment) with Hanna trephina tion (8 mm) and a running 10-0 nylon suture. Postoperative suture adju stment was done during the first postoperative month in all patients w ho had more than 3.5 diopters of astigmatism. Refraction and computeri zed topographic analysis were performed at 1 and 6 months postoperativ ely. Results: Intraoperative suture adjustment significantly decreased postkeratoplasty topographic (P = 0.0001) and refractive (P = 0.0001) astigmatism and improved best spectacle-corrected visual acuity (P = 0.0019) during the first postoperative month. Seventy-seven percent of control patients (mean topographic astigmatism, 4.89+/-1.99 D at 1 mo nth), but no patients who underwent intraoperative suture adjustment ( mean topographic astigmatism, 1.50+/-0.74 D at 1 month), required at l east one postoperative suture adjustment that delayed optical stabilit y and increased postoperative complications. At 6 months postoperative ly, mean topographic (P = 0.06) and refractive (P = 0.0001) astigmatis m were smaller in the intraoperatively adjusted group than in the cont rol group with postoperative suture adjustments. After intraoperative adjustment, best spectacle-corrected visual acuity was better(P = 0.01 68, P = 0.0434) and corneal topography was more regular (P = 0.02, P = 0.07, NS) at 1 and 6 months, respectively, than after postoperative a djustment. Conclusion: Visual rehabilitation with decreased postkerato plasty astigmatism and more regular corneal topography was attained mo re rapidly and safely with intraoperative suture adjustment.