Sequential selective same-day suture removal in the management of post-keratoplasty astigmatism.

AIMS: In a previous study, we proposed that corneal topography performed 30-40 min after the initial suture removal can identify the next set of sutures requiring removal, for the treatment of post-keratoplasty astigmatism. The aim of this study was to evaluate the effect of removing subsequent sets of sutures at the same sitting. METHODS: 10/0 nylon interrupted sutures were placed, to secure the graft-host junction, at the time of keratoplasty. Topography was performed using Pentacam (Oculus) before suture removal. The sutures to be removed in the steep semi-meridians were identified and removed at the slit-lamp biomicroscope. Topography was repeated 30-40 min post suture removal, the new steep semi-meridians determined, and the next set of sutures to be removed were identified and removed accordingly. Topography was repeated 4-6 weeks later and the magnitude of topographic astigmatism was recorded. A paired-samples t-test was used to evaluate the impact of selective suture removal on reducing the magnitude of topographic and refractive astigmatism. RESULTS: Twenty eyes of 20 patients underwent sequential selective same-day suture removal (SSSS) after corneal transplantation. This study showed that the topographic astigmatism decreased by about 46.7% (3.68 D) and the refractive astigmatism decreased by about 37.7% (2.61 D) following SSSS. Vector calculations also show a significant reduction of both topographic and refractive astigmatism (P<0.001). CONCLUSION: SSSS may help patients to achieve satisfactory vision more quickly and reduce the number of follow-up visits required post keratoplasty.

Intra-lesional 5 fluorouracil for the management of recurrent pterygium.

AIM: Recurrence is the most common complication arising from pterygium surgery. The aim of this study was to investigate the effectiveness of 5 fluorouracil (5FU) in halting the recurrence of pterygium after surgical excision. METHODS: A retrospective review of patients treated for pterygium recurrence was carried out. Patients with recurrent (secondary) pterygium were treated with multiple weekly intra-lesional injections of 0.1-0.2 ml (2.5-5 mg) 5FU post-operatively depending on the size of the recurrence. The treatment was started within 1 month from the date of recurrence. The time from surgery to start of recurrence, previous treatment modalities, and number of recurrences were documented. The number of injections required to induce arrest of progression and/or regression of vascularity and fleshiness of the pterygium and any complications related to 5FU treatment were examined. RESULTS: Fifteen eyes from 14 patients with recurrent pterygium treated with intra-lesional 5FU injections were analysed. Three of the 15 eyes had undergone a secondary excision and 12 had undergone a primary excision. In all, 93.3% of patients showed regression of the fibrovascular tissue (thickness and vascularity) and arrest of progression following a dose of 0.1-0.2 ml (2.5-5 mg) 5FU. Twelve eyes required three injections or fewer, whereas one patient required eight injections. This beneficial effect was maintained over an average follow-up period of 17 months. No complications from 5FU were observed. CONCLUSION: The use of weekly intra-lesional 5FU injections for the treatment of recurrent pterygium is safe and effective in limiting the progression and inducing the regression of recurrent pterygium. The number of injections can be tailored according to clinical need.

Rapid suture management of post-keratoplasty astigmatism.

AIM: Post-keratoplasty astigmatism is managed by topography-guided suture removal. This can take several weeks until satisfactory reduction in astigmatism is achieved. This study aimed to assess whether topography performed 30-40 min after the removal of the first pair of sutures would predict the next set of sutures requiring removal. METHODS: A prospective study of 20 consecutive penetrating keratoplasty patients was carried out. Topography guided suture removal in the steep meridian was carried out. Topography was repeated after 30-40 min and 4-6 weeks later. The tight sutures requiring removal were identified for each occasion and compared. The difference was considered insignificant if the axes of sutures requiring removal was <22.5 degrees. Paired t-test and chi (2) were performed for statistical analysis. RESULTS: In 85% of individuals, the 30-40 min topography gave an accurate indication of the next pair of sutures requiring removal. The difference in mean astigmatism at 30-40 min post suture removal (4.37+/-2.08 D) and at 4-6 weeks (4.24+1.97 D) was not significant (P=0.150). However, the difference between vector-corrected change of topographic astigmatism at 30-40 min after suture removal and at 4-6 weeks (1.72 D) was significant (P<0.001). Improved best-corrected visual acuity was seen in 50% of patients. CONCLUSION: This study showed that corneal topography performed 30-40 min after suture removal can identify the next set of sutures requiring removal. This can be used as a guide to remove more sutures at the same visit, thereby expediting post-keratoplasty visual rehabilitation and reducing the number of follow-up visits.

Re-treatment after laser in situ keratomileusis for correction of myopia and myopic astigmatism.

AIM: To evaluate the results of laser in situ keratomileusis (LASIK) re-treatment for under correction or regression after primary LASIK procedures for myopia and myopic astigmatism. METHODS: A prospective evaluation of 360 consecutive LASIK-treated eyes, for myopia and/or myopic astigmatism, 32 eyes of 34 patients were retreated and followed at 3, 6 and 12 months post-retreatment. Re-treatment was performed by lifting the original flap after cutting the epithelium around the flap edge with a fine needle. Standard ablation was performed based on the patient's residual refraction. RESULTS: 9.4% of eyes required retreatment. Prior to re-treatment the mean manifest spherical equivalent (SE) was -0.99 (SD 1.48) D (range -0.75 to -2.63). The mean sphere was -0.79 (1.20) D (range -2.50 to -0.50), and the mean cylinder was -0.90 D (1.14) D (from -2.75 to 1.25). At 1-year follow-up 56% of the eyes were within +/-0.50 D SE, and 78% were within +/-1.00 D SE. 78% of the eyes examined at 1-year post-re-treatment managed unaided vision of 6/9 or better. Peripheral epithelial ingrowth not requiring treatment developed in two eyes. Second re-treatment for regression was performed in one eye. A significant correlation was found between the refractive regression and each of the following: preoperative refraction, attempted correction and ablation depth. CONCLUSION: LASIK re-treatment for residual myopia, by lifting the original flap, is an effective option. Refractive results are fairly predictable, and refraction stabilises by 3 months after re-treatment. Lifting the corneal flap after cutting the epithelium on the flap edges is easy to perform and has a very low incidence of epithelial ingrowth.