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C.G. Saad, I.J. Udell; Suture Infiltrates After Penetrating Keratoplasty . Invest. Ophthalmol. Vis. Sci. 2006;47(13):2763.
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To evaluate the frequency of suture infiltrates (SIs) after penetrating keratoplasty (PK) as well as the risk factors that predispose to their development. To review the outcome of suture infiltrates and to determine the most effective management strategies.
A retrospective chart review of 261 consecutive penetrating keratoplasties in 247 eyes of 233 patients was completed. The cause for corneal pathology, past ocular history, past medical history, time to presentation, management, and outcome were evaluated. Suture infiltrates that occurred within one month of penetrating keratoplasty were termed early suture infiltrates (ESIs). Those that occurred more than one month after penetrating keratoplasty were labeled as late suture infiltrates (LSIs) and were cultured.
Fifteen percent (38/261) of penetrating keratoplasties developed suture infiltrates. Eighty four percent (32/38) were ESIs. Sixteen percent (6/38) were LSIs and were associated with an infectious etiology. Suture loosening occurred in 12 of the 38 PKs (32%) with SIs and resulted in early suture removal in 6 of the PKs (16%). Twenty seven percent (4/15) of PKs performed for herpes simplex virus and twenty six percent (7/27) of PKs performed for keratoconus developed suture infiltrates. Sixty three percent (5/8) of PKs performed for a non–herpetic ulcer developed suture infiltrates. Six of the 38 corneas with SIs (16%) had pre–operative vascularization. All patients with floppy eyelid syndrome developed suture infiltrates (3/261). All PKs with ESIs were treated aggressively with topical steroid. The addition of oral steroids was necessary in 4 PKs in order to stabilize the graft. Ninety four percent (30/32) of ESIs resolved completely with aggressive use of steroid. Two of the four grafts treated with oral steroids required resuturing of the graft in the operating room. Antibiotics alone were used to treat LSIs which were more typically associated with an adjacent keratitis and were culture positive for a range of organisms (enterobacter cloacal, staph. aureus, and strep. viridans).
Suture infiltrates after PK are more common than previously described. Patients with preoperative inflammatory conditions, keratoconus, corneal vascularization, and floppy eyelid syndrome appear to be at increased risk for developing suture infiltrates after PK. In high risk patients for ESIs, the early and aggressive use of topical steroids is necessary. The use of interrupted sutures should be considered in high risk patients as the early removal of a running suture would require return to the operating room. In the LSI group, SIs should be managed with antibiotics.
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