Intermittent sliding-lock-knot suture for limbal conjunctival autograft fixation in pterygium surgery:a technique note

AIM:To report a technique used with intermittent slidinglock-knot(ISLK)fixation for limbal conjunctival autografts in pterygium surgery and compared with those of routine intermittent(RI)fixation.METHODS:Consecutive patients with primary pterygium who had undergone pterygium excision combined with limbal conjunctival autograft transplantation between March 2021 and March 2022 at our institute were retrospectively analyzed.Primary outcome measures were mean duration of surgery and suture removal,degree of conjunctival hyperemia on postoperative day 1,pain score at suture removal,postoperative symptoms at 6mo,including conjunctival hyperemia,foreign body sensation,and graft stability.RESULTS:Ninety-eight patients underwent monocular surgery and were divided into ISLK(51 eyes)and RI(47 eyes)groups according to the type of conjunctiva autograft fixation method planned.There was no significant difference in mean duration of surgery between the two groups(18.59±2.39min vs 18.15±2.20min,P=0.417);however,compared to the RI group,shorter suture removal times were observed in the ISLK group[0.58min(0.42-0.87)vs 3.00min(2.21-4.15),P<0.001].The degree of conjunctival hyperemia on postoperative day 1 was milder in the ISLK group(P<0.001).Pain scores at suture removal were lower in the ISLK group than in RI group[1(0-3)vs 2(1-4),P<0.001].Postoperative symptoms at 6mo were comparable between the groups(P=0.487),with no recurrence.CONCLUSION:ISLK is an innovative method for limbal conjunctival autograft fixation after pterygium excision.Compared to RI fixation,ISLK facilitates suture removal and reduces discomfort,with comparable surgery duration and less conjunctival hyperemia.

Changes in post-keratoplasty astigmatism after suture removal:refraction vs tomography vs aberrometry

AIM:To analyse the changes in magnitude and orientation of astigmatism after suture removal(SR)in keratoplasty eyes as measured by refraction,tomography,and aberrometry.METHODS:Twenty-six eyes of 25 patients after optical keratoplasty requiring SR to reduce the astigmatism during the follow-up period were prospectively included.Eyes with poor quality topography scans or if there were no sutures in the steepest semi meridian were excluded.Corrected distance visual acuity(CDVA),manifest refraction,corneal tomography and aberrometr y were per formed on all patients before and after SR.RESULTS:The mean age of the patients was 40.8±14.4 y.Penetrating keratoplasty was performed in 23 eyes(89%)and deep anterior lamellar keratoplasty was done in 3 eyes(11%).There was a statistically significant reduction in the magnitude of refractive,tomographic and aberrometry astigmatism after SR(P<0.001)at 2 h after suture removal.The mean net reduction of the astigmatism was greater as measured by corneal tomography compared to refractive astigmatism(P<0.05).There was no statistically significant change in refractive astigmatism between 2 h and 2 mo after SR(P=0.55).Vector calculations demonstrated a greater amount of undercorrection in the tomography group and the rotational error was more towards counterclockwise direction.Mean monocular log MAR CDVA improved from 0.57 D to 0.49 D after SR(P=0.002).CONCLUSION:The net reduction in the magnitude of astigmatism after SR is greater in the tomography and aberrometry groups.With one episode of SR,there is no difference in the aberration profile.