Corneal topography-guided penetrating keratoplasty and suture adjustment -: New approach for astigmatism control

Purpose: To describe a new keratoplasty procedure using intraoperative topography to reduce postoperative astigmatism. Methods: One hundred sixty-five eyes of 150 consecutive patients were enrolled in this prospective study. The most common diagnosis was ketatoconus (78.8%). As many as 5.5% had post laser in situ keratomileusis ectasia. Keratoplasty was performed with the Hanna Corneal Trephine System. A 24-bite running suture was placed, using a specially developed marker. Suture adjustment was performed with the aid of an intraoperative topographer (Keratron Seoul; OPTIKON 2000, Rome, Italy). The aim of the adjustment was to obtain an astigmatism <= 2.0 D on the operating table. In case of >3.0 D of astigmatism at 1 month after surgery, suture adjustment was performed using the same intraoperative topographer. Results: At 12 months postoperatevely (Suture in), data from 108 (64%) eves were available. The mean refractive astigmatism was 3.53 D, and the mean topographical astigmatism was 4.7 D. At 18 months (suture out), data from 32 eyes (19.4%) were available, and at 24 months, data from 29 eyes (13.3%) were available. The mean refractive astigmatism was 3.39 D at 18 months and 3.47 D at 24 months. The mean topographic astigmatism was 2.30 D at 18 months and 1.76 D at 24 months. Mean best spectacle-corrected visual acuity (BSCVA) was 0.51 at 3 months, 0.63 at 12 months (suture in), 0.67 at 18 Months (suture out), and 0.78 at 24 months postoperatively. Conclusions: The combination of intraoperative topography and a 24-bite single running suture resulted in a stable astigmatism throughout the follow-up period, even after suture removal. BSCVA reached a 20/40 level as early as 3 months postoperatively and continued to rise after suture removal. The stability of astigmatism and BSCVA shortened the postoperative visual rehabilitation time and provided a high quality of vision early in the postoperative period.