Selective suture removal in astigmatism after conventional cataract surgery

Aim: Cataract is one of the major single causes of curable blindness in India. Our duty ends only after giving good visual acuity to these patients undergoing cataract extraction surgery. Post operative corneal astigmatism following cataract surgery plays a key role for predicting results in an otherwise perfect and successful operation. The need for improved uncorrected visual acuity either owing to spectacles or contact lenses is the basis for surgical procedures for reducing astigmatism. Finer sutures such as 10.0 monofilament nylon and 9.0 silk which are intended to remain in situ tend to compress the wound thus an effective method of reducing or eliminating the wound compression is the removal of one or more interrupted sutures in the meridian of greatest corneal curvature or in the serving of a continuous suture in the area of the steepest corneal meridian. Our primary aim of the study is to Document the corneal astigmatism following cataract extraction and IOL implantation. Effect of selective suture cutting/selective suture removal of the astigmatism. Predictability of result of corneal astigmatism after suture cutting. Materials and Methods: 50 patients who underwent conventional extra capsular cataract surgery with or without intraocular lens were recruited for the study. Pre operative keratometric readings with Bausch and Lomb keratometer and retinoscopy was done to assess the magnitude and axis of the cylinder. Extra capsular cataract surgery was performed as per standard protocol and procedure. Incision was closed with interrupted sutures. Patients were divided into pseudophakic and aphakic groups. Keratometric readings and best corrected visual acuity with subjective correction was obtained at one, three and six weeks post operatively. At sixth week selective suturotomy/suture removal was carried out it in the direction of plus cylinder. Number of sutures removed depend on the magnitude of cylinder. Result: Post operative astigmatism was high at first week which gradually decrease and stabilize by sixth week. At sixth week patients had variable amount of astigmatism ranging from 0-7D. Average decrease in astigmatism post suture removal was 1.08D, 2.06D, 3.5D following one, two and three suture removal. Post suture removal 26% patients had no astigmatism, 24% had WTR, 40% had oblique and 10% had ATR astigmatism. Conclusion: The interrupted sutures and their removal at appropriate time are recommended to create a spherical equivalent of refraction.