PK suture removal carries risk despite passage of time

LEXINGTON, Ky. — Removal of a single continuous suture after penetrating keratoplasty carries a risk of spontaneous wound dehiscence even at 2 years or more postoperatively, according to a study here.

Edward Abou-Jaoude, MD, and colleagues at the University of Kentucky College of Medicine advise surgeons to caution PK patients about the risk and symptoms of wound dehiscence before suture removal. Such counseling may facilitate early recognition and intervention for preservation of vision, they said.

Older patients, especially those who had PK for corneal edema with postop astigmatism and who have been using corticosteroid drops for prolonged periods of time, are at an increased risk of wound dehiscence, they added.

Dr. Abou-Jaoude retrospectively reviewed 324 continuous suture PKs performed between 1992 and 1999; of these, 69 had the continuous suture removed. Suture removal times after PK averaged 2 years and ranged from 3 to 63 months. Five of the eyes developed spontaneous wound dehiscence without direct eye trauma; these eyes had the sutures removed between 14 and 42 months post PK. Dehiscences occurred between 3 and 18 days after suture removal.

History associated with wound dehiscences included coughing, yawning, falling without trauma to the eye and spontaneous wound separation.

In four of the five patients, suture removal was necessary for astigmatism; the other patient had a broken suture. In four of the five patients, the location of wound dehiscence correlated with the steep axis of corneal keratometry before suture removal. Surgical intervention preserved the presuture-removal best-corrected visual acuity in four of the five eyes. None of the eyes with an intact suture spontaneously dehisced.

The study is published in the July issue of Ophthalmology.