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Michelle Overturf, Bethany Markowitz; Comparison of Postoperative Change in Corneal Astigmatism after Small Biplanar Incision Cataract Surgery With and Without Wound Suture as Performed by a Resident Surgeon. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):1905.
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© ARVO (1962-2015); The Authors (2016-present)
Corneal incisions relax corneal steepening along the axis of incision. Thus, the temporally placed self-sealing clear corneal incision (CCI) used during cataract surgery is known to slightly reduce against the rule (ATR) astigmatism. However, a surgeon may choose to place a suture at the CCI site at the end of surgery, to ensure the wound remains water tight. We hypothesized that the reduction in ATR astigmatism seen from a temporal CCI wound would be lessened when a suture was placed through the CCI as compared to a sutureless CCI.
Twenty-two eyes with preoperative ATR astigmatism (as determined by IOL Master K readings) had cataract surgery performed via a biplanar CCI (made with a 2.4mm keratome) by the same resident surgeon. A 10-0 nylon suture was placed through the CCI wound at the end of surgery in 5 of the cases; the remaining had no suture placed. There were no visible intraoperative wound changes at the end of surgery, and all eyes were Seidel negative on postop day 1. All sutures were removed at postop week 3. Subjective manifest refraction was measured at postop week 5. Eyes that had a CCI wound suture placed were then compared to those without a suture.
Of the 5 eyes that had a CCI wound suture placed, the mean preop corneal astigmatism was 0.76 diopters; the mean change in pre- v.s. postop corneal astigmatism was -0.6 diopters. Of the 17 eyes that did not have a suture placed, the the mean preop corneal astigmatism was 0.762 diopters; the mean change in pre- v.s. postop corneal astigmatism was -0.4 diopters.
A temporally placed self-sealing biplanar CCI is known to decrease ATR astigmatism. A suture may be placed at the CCI wound to ensure the eye remains water tight at the end of surgery. At postop week 5 there was no difference in the change in ATR corneal astigmatism in eyes that had a suture initially placed as compared with those that had no suture placed. Due to inexperience, resident surgeons are more likely to induce wound instability, and thus to use a suture for securing the CCI wound. Resident surgeons should not hesitate to use a suture to secure the CCI wound at the end of surgery; the final change in postop corneal astigmatism, in eyes with preop ATR astigmatism, will not be affected by placement of a suture at the CCI wound.
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