Transcript Resuturing following Penetrating Keratoplasty: Incidence

Resuturing following Penetrating
Keratoplasty: Incidence, Clinical Profile and
Outcome
Sonika Gupta, MS
Consultant Ophthalmology
Max Eye Care
New Delhi, India
Author has no financial interest
Purpose of study
To evaluate the clinical profile and outcome
of cases requiring resuturing following
penetrating keratoplasty (PKP).
Methods
Study design and participants: In a
retrospective case analysis of 258 consecutive
PKP procedures performed from July 2004 to
June 2008, medical records of patients who
were admitted for resuturing of the corneal
grafts were analyzed.
.
Methods
• Main parameters analyzed: Indications for
PKP, time from PKP to resuturing, causes of
resuturing, post-resuturing complications,
visual outcome, and graft status.
• Surgical technique: Similar method in all
patients that involved a donor button oversized
by 0.5 mm and placement of 16 interrupted
sutures or 20 bite continuous running sutures
Clinical pictures of some cases of PKP requiring resuturing
Fig.1: wound
dehiscence inferiorly
Fig.2 : loose suture
at 2’o clock
Fig.3: unsatisfactory
wound closure
Fig.4: wound gape
with infiltrates inferiorly
Results
• Resuturing was performed in 8.9% (23 eyes of
23 patients) .
• Mean age of patients = 49.74 ± 16.529 years ;
14 males, 9 females
• The incidence of resuturing was greater in
cases operated for infective keratitis
(16/113;14.1%) than for other indications
(7/145; 4.8%, p=0.009 chi- square test
Results
Indications for PKP in resutured grafts were
infective keratitis in 16 eyes (69.5%), bullous
keratopathy 4 eyes (17.3%), corneal scar 3
eyes (13%).
Fig 5: Indications for PKP in resutured
grafts
Infective Keratitis
13%
Bullous
Keratopathy
Corneal Scar
17%
70%
Results
The main causes of resuturing: loose sutures in 12
eyes (52.1%) , unsatisfactory wound closure 6 eyes
(26%), wound dehiscence 3 (13%) and broken sutures
2 (8.7%).[Fig 6]
Fig 6 : Causes of resuturing in % of
cases
60
Loose Sutures
52.1
Unsatisfactory
wound closure
40
26
20
0
13
8.7
Wound
Dehiscence
Broken
Sutures
Results
• The median time between PKP and resuturing
was 14 days (range 1-120 days).
• Complications : graft infection(13%) and
endophthalmitis (4.3%).
• Visual acuity of ≥ 6/18 observed in 39.1%
eyes over a mean follow-up period of 8.6 ±
4.20 months.
Conclusion
• Resuturing of corneal wound after PKP is required
for various suture-and wound-related complications
including loose sutures and wound dehiscence.
• Our results suggest that resuturing is most commonly
required for PKP done for infective keratitis. The
presence of severe ocular surface inflammation in
these patients may contribute to suture related
problems. Close monitoring is recommended in such
cases.
Conclusion
• Sutureless surgical procedures like Descemet’s
stripping automated endothelial keratoplasty
(DSAEK) may be preferred in cases requiring corneal
transplantation for endothelial decompensation.
• Deep anterior lamellar keratoplasty (DALK) may be
encouraged in superficial and stromal corneal disease
as risk of wound dehiscence is very low in DALK .
• With new technologies such as femtosecond laser,
superior mechanical stability of corneal wound is
achieved, thereby reducing the risk of wound
dehiscence.