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Intraoperative topography enhances keratoplasty outcomes, study shows

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Using intraoperative topography to guide the placement of a 24-bite single running suture during keratoplasty procedures can help reduce postoperative astigmatism, according to a study by researchers in Italy. The resulting astigmatic stability can also shorten postoperative visual rehabilitation, the authors noted.

Paolo Vinciguerra, MD, and colleagues at the Istituto Clinico Humanitas prospectively evaluated the new procedure in 165 eyes of 150 consecutive patients. Indications for surgery included keratoconus in 78.8% of cases and post-LASIK ectasia in 5.5%, according to the study.

Surgeons performed keratoplasty using the Hanna corneal trephine system (Moria) and then placed a 24-bite running suture using a specially designed marker. The suture was adjusted with the aid of a topography system (Keratron Scout, Optikon) to achieve an intraoperative astigmatism of 2 D or less.

The same topography system was used for additional suture adjustment in eyes that had more than 3 D of astigmatism at 1 month follow-up, according to the study.

The researchers found that, among 108 eyes with available 12-month follow-up data, refractive astigmatism averaged 3.53 D and topographic astigmatism averaged 4.7 D with the suture still in place.

At 18 months follow-up among 32 eyes with the suture removed, refractive astigmatism averaged 3.39 D and topographic astigmatism averaged 2.3 D.

Follow-up data at 24 months were available for 29 eyes. Among these eyes, refractive astigmatism averaged 3.47 D and topographic astigmatism averaged 1.76 D. The suture had been removed in all these eyes, according to the study.

Best corrected visual acuity averaged 0.51 at 3 months, 0.63 at 12 months, 0.67 at 18 months and 0.78 at 24 months, the authors reported.

"The combination of intraoperative topography and a 24-bite single running suture resulted in a stable astigmatism throughout the follow-up period, even after suture removal," they wrote. "The stability of astigmatism and [BCVA] shortened the postoperative visual rehabilitation time and provided a high quality of vision early in the postoperative period."

The study is published in the July issue of Cornea.