Investigation On The Effect Of Optical Penetrating Keratopalsty By No Torque Pattern Double Running Suture Technique

Investigation on the effect of optical penetrating keratoplasty by no torque pattern double running suture techniqueObject A no torque pattern double running Suture technique was designed for the optical penetrating keratoplasty to modified the traditional corneal suture methods for more satisfy postoperative optical effect.Methods This research is a prospective randomized controlled trial. Fifty-six resident patients in Shandong Provencial Qianfoshan Hospital during January2011till June2013, who need to be undergoing an optical penetrating keratoplasty were divided into two groups randomly. The trial group practiced no torque double running suture, total of28people,28eyes,13eyes with keratoconus, corneal leucoma in7eyes,5cases with bullous keratopathy, corneal degeneration3eyes.The control group practiced interrupted suture, a total of28people,28eyes,10eyes with keratoconus, corneal leucoma in10eyes,4cases with bullous keratopathy, corneal degeneration4eyes. The preoperative examinations include slit-lamp exam, visual acuity test all the diagnosis were identified. General anesthesia with endotracheal intubation was induced by intravenous drugs were used on all of the patients. All the surgeries were completed by one surgeon. At the first day after the surgery, every patient was treated by the following medicines,levofloxacin Eye Drops, Tobramycin and Dexamethasone eye drops,4times a day, Tobramycin and Dexamethasone Ophthalmic Ointment apply eye, once every night. After one month, the eye drops changed into3times daily, and tapering till to2months. At2weeks after operation application Cyclosporin Eye Drops were used, three times a day, for a year. With one year following-up observation. Analysis different indexes in four time points after the surgery, that including2weeks,2monthes,6monthes and one year. The following indexes were recorded:the situation of the healing of the incision and the change of intraocular pressure during the early stage after surgeries (2weeks and2monthes); the BCAV, changes of the corneal curvature and astigmatism in these four time-points, Compare the different of these indexes between the trial group and the control group.Results1. The best correct visual acuity:the trial group (4.53±0.18)get a higher increase than the control group (4.31±0.23),1.53±0.52vs1.16±0.50(Paired t test, t=3.217, P<0.05).2. Comparison of topographic astigmatism:At the early stage of postoperation, there was a significant different between the trial and control group (t test, t=-11.765, P<0.001). From the beginning of the6month after the surgeries, the astigmatism gap narrowing, but the difference was statistically significant (t test, t=-7.458, P<0.001). At12months, there was no change in the trial group than6months, however,the control group astigmatism decreased significantly, there was no significant difference between trial and control group (t test, t=-0.929, P>0.05);3. Comparison of objective refraction astigmatism:there was a significant different between the trial and control group (t test, t=-14.648, P<0.001). From the beginning of the6month after the surgeries, the astigmatism gap narrowing, but the difference was statistically significant (t test, t=-3.777, P<0.001).At12months, there was no change in the trial group than6months, however,the control group astigmatism decreased significantly, there was no significant difference between trial and control group (t test, t=-1.151, P>0.05);4. The postoperative refractive state is more stable in trial group than the control group. The latter with the changes of postoperative astigmatism and gradually reduced.5. Postoperative complications of trial group:scar formation of incision is larger (1case), knot exposed (1case), one of running suture loosening (1case), immune rejection (1case), complicated cataract (4cases) and pupil fixed enlargement (1case).Conclusions:The no torque double running suture technique can get a favourable BCVA in the early stage after the optical penetrating keratoplasty. Postoperatively, the technique can get a stable refractive state.The postoperative astigmatism is less than the control group; This technique follows the principle to establish reference suture continuously. The direction of each suture and the internal and external suturing angle between the neighbouring sutures were quantified. It lead the suture process more standardized, accurate, and avoid the randomness and blindness of tranditional double continuous suture technique; the same suture angle lei corneal graft and the graft bed full weeks with uniform, increased more security, also make the corneal appearance more beautiful. The same suture angle make the whole corneal graft and the bed bear averaged force, more safety. They also make the corneal surface looked more artistic.