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Adjustment of Running Suture to Control Postkeratoplasty Astigmatism
Letters to the Editor Adjustment of Running Suture to Control Postkeratoplasty Astigmatism
4. Atkins AD, Roper-Hall MJ. Control of postoperative astigmatism. Br J Ophthalmol 1985; 69:348-51. 5. Roper-Hall MJ. Stallard's Eye Surgery. 1989; 243-4; Butterworth.
Dear Editor: While attending the International Congress of Ophthalmology in Singapore last year, Lwas very interested to hear Professor Herbert Kaufman mention work on the control of corneal astigmatism by adjustment of a continuous suture. He sent me copies of the interesting and relevant articles published in Refractive and Corneal Surgery' and in Ophthalmology.' I have used this method for over 10 years and a report was published in 1982. 3 In that article I wrote: "Adjustment of a continuous suture or removal of one or more selected interrupted sutures during the early postoperative weeks can allow a refined control." "It can be applied to corneal distortion following trauma as well as cataract extraction and keratoplasty." Later in the same article, the method is described: "It is possible to adjust the tension of a continuous suture by sliding it along the wound. The power and axis of astigmatism is established. Microsurgical suture forceps can be used to grip the continuous polyester suture through the corneal epithelium and ease it towards the tight meridian (the + axis). The change of refraction is usually immediate, and after reassessment the adjustment can be repeated if necessary." There is an illustration ofa case in which such readjustment was necessary after 2 weeks before stability was maintained. A group of 36 patients in which this method was used was studied prospectively and reported in 1985.4 The technique was again described. We delayed adjustment until the sixth or eighth week because of the slight risk of breaking the suture. This article also has a figure illustrating an example, and scattergrams showing the immediate and late results. I have spoken about the method in discussion at a number of meetings with an international attendance: the International Ophthalmic Microsurgery Study Group and the Oxford Ophthalmological Congress, as well as at regional Society meetings. The technique also is d~scrib~d in the new edition of Stallard's Eye Surgery, published In 1989, which I revised.' The method is certainly valid and I am glad that your work is stimulating more interest. MICHAEL J. ROPER-HALL Birmingham, United Kingdom References 1. McNeill JI, Wessels IF.Adjustment of single continuous suture to control astigmatism after penetrating keratoplasty. Refract Corneal Surg 1989; 5:216-23. 2. Lin DTC, Wilson SE, Reidy JJ, et al. An adjustable single running suture technique to reduce postkeratoplasty astigmatism. Ophthalmology 1990; 97:934-8. 3. Roper-Hall MJ. Control of astigmatism after surgery and trauma. Br J Ophthalmol1982; 66:556-9.
Authors' reply
Dear Editor: We appreciate Dr. Roper-Hall's comments regarding our prospective, randomized study on an adjustable single running suture technique to reduce postkeratoplasty astigmatism. 1 Indeed, he has described a technique for postoperative adjustment of a running suture to control astigmatism.v' In these reports, however, suture adjustment techniques were only applied to the control ofastigmatism after cataract surgery. Although the possibility of applying this technique to penetrating keratoplasty was mentioned in one report.' the only corneal transplant case that was described had astigmatism controlled by the removal of interrupted sutures. The topographic alterations induced by penetrating keratoplasty, in which a 360 0 perforating incision is made in the cornea, are more complex and frequently accompanied by higher levels of irregular astigmatism than those induced by cataract surgery. Therefore, we believe that the report by McNeill and Wessels" on the adjustment of a single running suture to control astigmatism in 330 transplanted corneas in large part deserves the credit for stimulating the recent advances in this area. Our study! demonstrates that the technique described by McNeill and Wessels is effective when investigated in a randomized, prospective study and provides additional details regarding the application of the technique to penetrating keratoplasty. . We agree that methods of corneal suture adjustment are valid and that they are important advances in the control of astigmatism after penetrating keratoplasty':" and, as Dr. Roper-Hall and his co-workers have reported.v' cataract surgery. DAVID T. C. LIN, MD Vancouver, Canada STEVEN E. WILSON, MD Dallas, Texas References 1. Lin DTC, Wilson SE, Reidy JJ, et al. An adjustable single running suture technique to reduce postkeratoplasty astigmatism. Ophthalmology 1990; 97:934-8. 2. Roper-Hall MJ. Control of astigmatism after surgery and trauma. Br J Ophthalmol 1982; 66:556-9. 3. Atkins A, Roper-Hall MJ. Control of postoperative astigmatism. Br J Ophthalmol 1985; 69348-51. 4. McNeill JI, Wessels IF.Adjustment of single continuous suture to control astigmatism after penetrating keratoplasty. Refract Corneal Surg 1989; 5:216-23.
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4. Atkins AD, Roper-Hall MJ. Control of postoperative astigmatism. Br J Ophthalmol 1985; 69:348-51. 5. Roper-Hall MJ. Stallard's Eye Surgery. 1989; 243-4; Butterworth.
Dear Editor: While attending the International Congress of Ophthalmology in Singapore last year, Lwas very interested to hear Professor Herbert Kaufman mention work on the control of corneal astigmatism by adjustment of a continuous suture. He sent me copies of the interesting and relevant articles published in Refractive and Corneal Surgery' and in Ophthalmology.' I have used this method for over 10 years and a report was published in 1982. 3 In that article I wrote: "Adjustment of a continuous suture or removal of one or more selected interrupted sutures during the early postoperative weeks can allow a refined control." "It can be applied to corneal distortion following trauma as well as cataract extraction and keratoplasty." Later in the same article, the method is described: "It is possible to adjust the tension of a continuous suture by sliding it along the wound. The power and axis of astigmatism is established. Microsurgical suture forceps can be used to grip the continuous polyester suture through the corneal epithelium and ease it towards the tight meridian (the + axis). The change of refraction is usually immediate, and after reassessment the adjustment can be repeated if necessary." There is an illustration ofa case in which such readjustment was necessary after 2 weeks before stability was maintained. A group of 36 patients in which this method was used was studied prospectively and reported in 1985.4 The technique was again described. We delayed adjustment until the sixth or eighth week because of the slight risk of breaking the suture. This article also has a figure illustrating an example, and scattergrams showing the immediate and late results. I have spoken about the method in discussion at a number of meetings with an international attendance: the International Ophthalmic Microsurgery Study Group and the Oxford Ophthalmological Congress, as well as at regional Society meetings. The technique also is d~scrib~d in the new edition of Stallard's Eye Surgery, published In 1989, which I revised.' The method is certainly valid and I am glad that your work is stimulating more interest. MICHAEL J. ROPER-HALL Birmingham, United Kingdom References 1. McNeill JI, Wessels IF.Adjustment of single continuous suture to control astigmatism after penetrating keratoplasty. Refract Corneal Surg 1989; 5:216-23. 2. Lin DTC, Wilson SE, Reidy JJ, et al. An adjustable single running suture technique to reduce postkeratoplasty astigmatism. Ophthalmology 1990; 97:934-8. 3. Roper-Hall MJ. Control of astigmatism after surgery and trauma. Br J Ophthalmol1982; 66:556-9.
Authors' reply
Dear Editor: We appreciate Dr. Roper-Hall's comments regarding our prospective, randomized study on an adjustable single running suture technique to reduce postkeratoplasty astigmatism. 1 Indeed, he has described a technique for postoperative adjustment of a running suture to control astigmatism.v' In these reports, however, suture adjustment techniques were only applied to the control ofastigmatism after cataract surgery. Although the possibility of applying this technique to penetrating keratoplasty was mentioned in one report.' the only corneal transplant case that was described had astigmatism controlled by the removal of interrupted sutures. The topographic alterations induced by penetrating keratoplasty, in which a 360 0 perforating incision is made in the cornea, are more complex and frequently accompanied by higher levels of irregular astigmatism than those induced by cataract surgery. Therefore, we believe that the report by McNeill and Wessels" on the adjustment of a single running suture to control astigmatism in 330 transplanted corneas in large part deserves the credit for stimulating the recent advances in this area. Our study! demonstrates that the technique described by McNeill and Wessels is effective when investigated in a randomized, prospective study and provides additional details regarding the application of the technique to penetrating keratoplasty. . We agree that methods of corneal suture adjustment are valid and that they are important advances in the control of astigmatism after penetrating keratoplasty':" and, as Dr. Roper-Hall and his co-workers have reported.v' cataract surgery. DAVID T. C. LIN, MD Vancouver, Canada STEVEN E. WILSON, MD Dallas, Texas References 1. Lin DTC, Wilson SE, Reidy JJ, et al. An adjustable single running suture technique to reduce postkeratoplasty astigmatism. Ophthalmology 1990; 97:934-8. 2. Roper-Hall MJ. Control of astigmatism after surgery and trauma. Br J Ophthalmol 1982; 66:556-9. 3. Atkins A, Roper-Hall MJ. Control of postoperative astigmatism. Br J Ophthalmol 1985; 69348-51. 4. McNeill JI, Wessels IF.Adjustment of single continuous suture to control astigmatism after penetrating keratoplasty. Refract Corneal Surg 1989; 5:216-23.
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