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Caleb Shumway, Sahil Aggarwal, Marjan Farid, Sumit Garg, Sanjay Kedhar, Matthew Wade; Femtosecond Laser-Enabled Keratoplasty with zig-zag pattern: Comparison of Suture Pattern. Invest. Ophthalmol. Vis. Sci. 2018;59(9):1335. doi: https://doi.org/.
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While there are several studies which show the outcome of suture pattern in traditional penetrating keratoplasty, suggesting that a single running suture may significantly improve rates of astigmatism, it is not known whether this is also true for patients who receive Femtosecond Laser Enabled Keratoplasty (FLEK). We performed a retrospective chart review of the patients who had received the FLEK procedure to determine what differences in outcomes may be associated with suture pattern.
288 patients (335 eyes) underwent FLEK with zig-zag incision configuration. Each patient received one of three different suture patterns, interrupted, single running, or combined (interrupted and single running sutures). The mean age at time of surgery across groups was 54.5 years ±16.6 and 36.4% of patients were female. The most common indications for surgery were keratoconus (38%), corneal scar (21%) and previous failed graft (16%). Overall, 146 eyes (43.6%) had interrupted sutures, 159 eyes (47.5%) had running sutures and 30 eyes (9%) had combined sutures. Patients were evaluated at regular intervals with follow-up up to 8 years. Outcome measures were uncorrected visual acuity, best spectacle corrected distance visual acuity (CDVA), topographic astigmatism, manifest astigmatism and keratometry. Visual acuity was reported in logmar, astigmatism was reported in diopters and ANOVA test was conducted to determine significance.
Patients who had single running sutures had significantly lower rates of astigmatism at early follow-up (1 month and 3 month) intervals (p<0.01) when compared to the interrupted and combined suture patterns. However, there was no significant difference in astigmatism after these time points, nor at the last postoperative appointment (p=0.34). It should be noted that there was a difference in preoperative corrected distance visual acuity (CDVA) among patients who received interrupted sutures. These patients had worse CDVA preoperatively, versus single running and combined sutures (p=0.046).
For those receiving FLEK with zig-zag pattern, patients who receive single running sutures have slightly lower astigmatism in early postoperative appointments than patients who receive interrupted or combined sutures. These results would best be confirmed by a prospective study, since those with better CDVA were also those who received sutures in a running pattern.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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