Abstract

Purpose: To compare the effect of 3 common suturing techniques on postkeratoplasty astigmatism and final best corrected visual acuity (BCVA) in patients with keratoconus. Methods: In this randomized clinical trial, 103 eyes of 103 patients with advanced keratoconus, who were contact lens intolerant, or with contact lens-corrected visual acuity less than 20/80, underwent penetrating keratoplasty with 3 suturing techniques: interrupted (IR), single running (SR), and combined interrupted and running (CIR). Postkeratoplasty astigmatism and BCVA were evaluated during regular examinations 1.5, 3, 6, and 12 months postoperatively and 2 months after complete suture removal. Suture adjustment and selective suture removal were performed 2 to 6 weeks and after 3 months in eyes with more than 4 D of corneal astigmatism in the SR and IR/CIR groups, respectively. Results: Of 87 patients who completed follow-up, 26 eyes underwent PK with interrupted suturing technique (IR), 26 eyes had single running sutures (SR), and in 35 eyes, the suturing technique was combined (interrupted + running sutures; CIR). Mean age was 27.2 +/- 8.4, 28.9 +/- 8.7, and 30.3 +/- 8.7 years, and postoperative astigmatism 1.5 months after surgery was 3.77 +/- 1.68, 5.48 +/- 2.09, and 4.10 +/- 1.79 D in the 3 groups, respectively (P = 0.015). However, 2 months after complete suture removal, final postoperative astigmatism was 3.83 +/- 1.65, 3.37 +/- 1.9, and 3.88 +/- 2.79 D (P = 0.851) and BCVA (log MAR) was 0.08 +/- 0.14, 0.13 +/- 0.23, and 0.09 +/- 0.16, respectively (P = 0.53). Immunologic endothelial rejection reactions were seen in 5 eyes (19.2) in the IR group, 3 eyes (11.72) in the SR group, and 6 eyes (17.64) in the CIR group (P = 0.44). There was no case of graft failure during the follow-up period. Conclusion: Postkeratoplasty astigmatism and BCVA are comparable with the 3 common suturing techniques (IR, SR, and CIR) in patients with keratoconus, provided that regular postoperative examinations and topography-guided suture adjustment and/or removal are performed.