UK Keratoconus Self-Help and Support Association

Ok now i am confused, well i always was but thought i'd post it here in the hope that someone would know the answer!

If your cornea has healed well after a graft and the graft is lovely and clear does it really matter when the stitches come out. I mean i have had to have some removed earlier than my surgeon would have liked but if they needed to come out anyway at some point does it really matter?

Also this point that he can control the astigmatism taking out stitches how does that work? Does he just select some to remove and then let it settle to see what happens? Am only thinking because to me a cut stitch is still a cut stitch and you can't really change that can you so i'm lost as to how this all works out.

Thanks for any advice!!

Sweet X x X

Funny, I asked my surgeon about this last time. He said if there was a perfect result, clear healthy cornea and a 6/6 view to see the world after years behind the KC carpet, there was no reason to remove the stitches. They simply let it be until they go out by themselves/dissolve etc. He also said the cornea ALWAYS change after stitch removal. So therfore they leave a perfect graft with the stitches in. Of course this practice may be different elswhere...

The sutures do not need to be removed..they can in theory stay in for the rest of your life!. However many dont do this as there is a slight risk of infection when there is a foreign body in the cornea....how high this risk is I dont know.

As far as astigmatism and sutures, the consultant will refer to the topography and slit lamp to determine at which point the cornea is irregular, tight, loose, etc. From this, he/she can estimate which suture needs to be removed to even out the surface....however this is more a skill than anything as the corneal surface is very very sensitive to even the slightest change!

J

Sweet,

Try sewing a circle of material over a hole in a pair of trousers. Sounds daft, but you will always get minute creases and this can lead to pulling on one side.

The surface I think heals quicker than the back. The back astigmatism of my cornea is about 1 diopter and the front used to be 8 diopters.

When everything went wrong in the right eye the back astigmatism was unchanged, but the front is up at 8 in places, 2 in others.

So the surgeon is trying to get a good abck surface as well as the front.

Beyond this, I can not offer any help.

That makes sense to me Gareth. With my 1st graft it initially looked perfect, but I'm not sure at what point the post graft astigmatism occured. With my 2nd graft I had to have stitches redone after they became loose, but I don't know what caused the shape to become very irregular, the stitches, the rejection or blood vessels growing in.

Yes, it's all about the shape of the graft, not just the clarity. When a cornea is initially transplanted, it is very swollen indeed, and the swelling reduces in the months after the graft.

As it shrinks, the shape will change if the tension in the sutures is not equal around the graft. (I think it is for that reason why some surgeons prefer a running stitch, as I imagine that it is slightly easier to keep an equal tension, but of course impossible to adjust later.) If the tension is uneven, the consultant will remove a few stitches which are pulling the graft out of shape. It's nothing to worry about and perfectly usual practice.

It's worth noting though that not all stiches can remain in place forever. It depends on the material used. I was told that mine ABSOLUTELY had to be removed before 3 years, as they'd start dissolving and breaking up. When she removed the running stitch at 2.5 years, she did comment that it was thinning in places!

Louise was it easy to have stitches redone or did you have to have a general? I have been told that i may need some at the bottom redone if it doesn't go as well as the surgeon would like.

Thanks for the comments

Sweet X x X

I read about this in another thread. Surprised, as I thought grafts were all done with local. They told me only downs syndrome patients get the full package. I certainly got no choice but to "watch" the entire procedure and chatting with the professor whilst sewing on the essentials....

Yes Sweet it was easy enough to have the stitches redone. I had a GA [wouldn't have wanted a local anyhow!] and I was done as a day case. I went back the following morning for them to take a look at it.

I was general anaesthetic for op - I managed to pass out when having stitches removed from left eye! I have a running stitch, so the whole lot will have to come out in one go. Not looking forward to hitting the deck again!