Complications of Mersilene Sutures in Penetrating Keratoplasty

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Abstract
BACKGROUND: After penetrating keratoplasty, many corneal surgeons adjust sutures to reduce astigmatism and then leave the sutures in place indefinitely. Nylon sutures can hydrolyze and break years after surgery. In a series of human penetrating keratoplasties, we studied the use of polyester (Mersilene®) sutures that do not hydrolyze. METHODS: We performed two prospective studies of polyester (Mersilene) sutures in human penetrating keratoplasty done by one surgeon. Study I was a randomized comparison of combined running and interrupted Mersilene and nylon sutures in 45 consecutive eyes. Study Il was a case series of single running Mersilene suture with postoperative adjustment of suture tension to manage astigmatism in 23 consecutive eyes. We evaluated the performance of the suture and the control of astigmatism. RESULTS: The interrupted running suture study demonstrated that interrupted Mersilene sutures were 5.5 times more likely to have handlingrelated complications than nylon Interrupted sutures (p = .01); in addition, they were three times as likely to have tissue-related complications as nylon (p = .16). The running suture study demonstrated an unacceptable complication rate of 69% when Mersilene was used as a single adjustable running suture. Af 6 months postoperatively, the median refractive astigmatism for the adjustable cases was 3.37 diopters (mean, 4.03 ± 2.37 D). Eyes with significant suture-related complications were 2.85 times more likely to have greater than 4.00 D of refractive astigmatism than were eyes without suture-related complications. CONCLUSIONS: Mersilene is an undesirable suture for use in penetrating keratoplasty. [Refract Cornea! Surg 1992;8;296-305.) RÉSUMÉ INTRODUCTION. Après kératoplastie transfixiante nombreux sont les chirurgiens rompus à cette technique qui tente de réduire l'astigmatisme secondaire par l'ajustement des sutures. Il est reconnu que les sutures en Nylon s'hydrolysent progressivement avec le temps. Nous rapportons sur une série de keratoplasties transfixiantes l'utilisation de sutures en polyester (MersileneR) connues pour leur stabilité. METHODES. Nous avons conduit deux études prospectives sur l'utilisation des sutures en polyester (Mersilene) dan les greffes de cornee. Des greffes ont éfé réalisées un seul chirurgion. Dans le première étude, nous avons comparé l'utilisation combinée de surjet de points séparés en Mersilène et en Nylon sur 40 yeux consécutifs. Dans l'étude numéro 2, nous avons réalisé un simple surjet en Mersilene avec un ajustement postopératoire de la tension de ces sutures pour améliorer l'astigmatisme sur 23 yeux consécutifs. Nous avons évalué l'efficacité de ces sutures et du contrôle de l'astigmatisme post-opératoire.