Refractive Results of Successful Penetrating Keratoplasty, Intraocular Lens Implantation With Selective Suture Removal

The refractive outcome in 44 eyes that had combined penetrating keratoplasty and intraocular lens insertion, with at least 6 months follow-up, was analyzed. All patients were operated on by the same surgeon using two types of trephines in all but one eye, and one suturing technique with nylon or dacron sutures. The intraocular lens power was calculated using SRK II formula with an assumed average post-operative keratometry of 45 D. The first refraction showed that the mean spherical equivalent was -0.20 +/- 3.45 D, the mean refractive astigmatism was 5.11 +/- 2.48 D and the average keratometry had a mean of 44.42 +/- 3.19 D. Modulation of postoperative astigmatism was done by selective removal of tight interrupted sutures, taking out one suture or maximally two sutures per visit, based on refraction, keratometry, and keratography criteria. The total number of sutures removed had a mean of 2.5 +/- 2.2 with a mean total number of visits of 5.3 +/- 2.0. The interval between visits had a mean of 4.5 +/- 1.9 weeks and the total duration of the suture removal phase was about six months. At the end of the refractive rehabilitation period, 73% of cases had a spherical equivalent between +3.0 D and -3.0 D and 61% of cases had an average keratometry within 2.5 D from our assumed value of 45 D. The mean postoperative refractive astigmatism was 2.5 +/- 1.5; 55% of cases had 3.0 D or less of astigmatic error and 90% of cases were within 4.0 D of postoperative astigmatism.