Resuturing following Penetrating Keratoplasty: Incidence, Clinical Profile and Outcome

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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

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Purpose of study

• To evaluate the clinical profile and outcome
  of cases requiring resuturing following
  penetrating keratoplasty (PKP).

3
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.
• .

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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

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Clinical pictures of some cases of PKP requiring
resuturing
Fig.1 wound dehiscence inferiorly
Fig.2 loose suture at 2o
clock
Fig.4 wound gape with infiltrates
inferiorly
Fig.3 unsatisfactory wound
closure
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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 (16/11314.1)
  than for other indications (7/145 4.8, p0.009
  chi- square test

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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).

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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

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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.

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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.

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Conclusion

• Sutureless surgical procedures like Descemets
  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.