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Veena Mathew, Christine P Lagler, Wuqaas M Munir; Iridocorneal adhesions after early selective suture removal in combined penetrating keratoplasty and cataract extraction with intraocular lens implantation. Invest. Ophthalmol. Vis. Sci. 2014;55(13):3142.
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To estimate the incidence of iridocorneal adhesions after first suture removal in simultaneous penetrating keratoplasty (PK), cataract removal, and intraocular lens implantation (triple procedure)
Retrospective case series of 19 triple procedures from September 2006 to October 2012 at Boston Medical Center. Exclusion criteria included pre-operative iridocorneal adhesions and those who were lost to follow-up prior to suture removal.
Fifteen of the 19 triple procedures reviewed had suture removal. The mean time interval for the initial suture removal after a triple procedure was 4.00+/-2.41 months (range 1.00-9.37 months). The incidence of post-operative iridocorneal adhesions subsequent to suture removal was 10 of 15 (66.7%). This occurred on average 4.20+/-2.67 months after suture removal. Five out of seven (71.4%) of those patients who had early selective suture removal prior to three months developed iridocorneal adhesions, compared to five out of eight (62.5%) of those who had suture removal after three months. The reasons for suture removal were astigmatism in 11 of 15 patients (73%) and a broken or loose suture in four of 15 (26.7%) patients. In those with astigmatic suture removal, seven out of 11 (63.6%) developed iridocorneal adhesions, and in those with broken or loose suture removal, three out of four (75%) developed iridocorneal adhesions.
The incidence of iridocorneal adhesions after suture removal in our case series of triple procedures was 66.7%. Patients who had early selective suture removal at less than three months developed iridocorneal adhesions more often than those with suture removal after three months. While there are advantages to early selective suture removal, the high rate of iridocorneal adhesions has clinical implications which must be considered, such as secondary angle closure glaucoma, pupil distortion, inflammation, and corneal vascularization, which may ultimately lead to graft failure.
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