Mersilene (polyester), a new suture for penetrating keratoplasty

Comparison of complication rates and postoperative astigmatism between nylon and mersilene sutures for corneal transplants in patients with Fuchs endothelial dystrophy

PURPOSE

The purpose of this study is to evaluate corneal astigmatism and suture-related complications for transplants sutured with nylon and transplants sutured with Mersilene in primary corneal transplants for Fuchs endothelial dystrophy.

METHODS

A retrospective, observational, and comparative study between transplants sutured with either nylon 10-0 or 11-0 (n = 108) or Mersilene 11-0 (n = 58) was done. One hundred sixty-six eyes of 140 patients who received a primary penetrating keratoplasty for Fuchs endothelial dystrophy between 1995 and 2001 at the Rotterdam Eye Hospital in Netherlands were included.

RESULTS

Overall, transplant survival did not differ between groups (log-rank test; P = 0.24). During the first 2 years after transplantation, significantly lower astigmatism was seen in transplants sutured with nylon (P = 0.03). Transplants sutured with Mersilene had a significantly higher risk of surgical intervention to correct astigmatism or wound dehiscence after transplantation (hazard ratio, 2.83; 95% confidence interval, 1.34-6.01). Time to first infiltrate, metaplasia (marked scarring along the sutures), or cheesewiring was significantly less in the Mersilene group (P < 0.01). There was a tendency toward a higher risk of complications associated with loose or broken sutures in the nylon group (hazard ratio, 2.00; 95% confidence interval, 0.57-6.98), which was more pronounced after 2 years.

CONCLUSIONS

During the first years after corneal transplant surgery, Mersilene sutures are associated with a higher risk of complications and more interventions to correct suture-related problems. However, after 2 years, the grafts seem to be able to retain Mersilene sutures with less risk of suture-related complications as compared with grafts with retained nylon sutures. These favorable long-term effects of Mersilene sutures may outweigh its short-term disadvantage in patients with Fuchs endothelial dystrophy.

Astigmatism After Mersilene and Nylon Suture Use for Penetrating Keratoplasty

PURPOSE

To evaluate postoperative astigmatism after the use of Mersilene and nylon sutures for penetrating keratoplasty.

METHODS

Two groups of 12 patients each (age, 20-50 years) suffering from keratoconus underwent penetrating keratoplasty. Continuous suturing combined with 12 interrupted sutures was used in each case: Mersilene 11-0 sutures were used in group 1, whereas nylon 10-0 sutures were used in group 2. Sutures were removed to control astigmatism when required. All patients were monitored for 36 months.

RESULTS

During the follow-up period, sutures were removed in each eye as indicated by astigmatism or breakage. In group 1 (Mersilene 11-0 sutures), no breakage of sutures was recorded. In group 2 (nylon 10-0 sutures), breakage of sutures was recorded in 11 of 12 cases. However, continuous sutures were removed in 2 patients in group 2. After the first year, the astigmatism remained within +/-1.00 diopter in all except 1 patient in group 1 and in 5 patients in group 2. No suture-related complications were recorded except for scarring with photophobia in 1 patient in group 1 and suture breakage in 11 eyes in group 2.

CONCLUSION

Mersilene sutures can provide a stable postoperative astigmatism, whereas nylon sutures have a tendency to break and cause changes in corneal astigmatism.

Comparison of suture-in and suture-out postkeratoplasty astigmatism with single running suture or combined running and interrupted sutures

PURPOSE

To evaluate postkeratoplasty astigmatism between two suture techniques 2 to 4 years postoperatively in a group of patients previously studied 9 months postoperatively.

METHODS

Thirty-two patients who underwent penetrating keratoplasty were randomly assigned to one of two groups. Group 1 (16 patients) had a 24-bite single running 10-0 nylon suture with postoperative suture tension adjustment; group 2 (16 patients) had combined 16-bite running and eight interrupted 10-0 nylon sutures with selective postoperative removal of interrupted sutures. During long-term follow-up, the running suture was removed in 19 patients (59%).

RESULTS

Postoperative astigmatism was slightly lower in patients with the single running suture technique when sutures were in place and was slightly greater after the sutures were removed compared with the combined running and interrupted suture technique (sutures in: single running suture +/- SD, 2.6 +/- 1.2 diopters [five patients, 31%]; combined running and interrupted sutures, 3.8 +/- 1.1 diopters [eight patients, 50%]; sutures out: single running suture, 3.3 +/- 1.3 diopters [11 patients, 69%]; combined running and interrupted sutures, 2.8 +/- 1.5 diopters [eight patients, 50%]). These differences were not statistically significant (sutures in, P < .13; sutures out, P < .46). Averages of follow-up were group 1,48.3 +/- 10.6 months and group 2, 46.3 +/- 13.0 months. Follow-up ranged from 23 to 60 months.

CONCLUSIONS

Postoperative astigmatism 4 years after penetrating keratoplasty is similar for these two suturing techniques, with or without residual sutures. A single running suture results in more rapid visual rehabilitation and less early astigmatism compared with the combined interrupted and running suture technique.