Computerized topography of selective versus all-suture release to manage high astigmatism after cataract surgery

Purpose: To compare the efficacy of selective suture release (SSR) with all-suture release (ASR) in controlling corneal astigmatism after cataract surgery. Setting: Sight Saver's Cornea Training Centre, L.V. Prasad Eye Institute, Hyderabad, India. Methods: This prospective, randomized study evaluated the effect on astigmatism of two techniques of suture release in 30 patients with more than 3.00 diopters (D) of corneal astigmatism after cataract surgery. All patients had interrupted sutures with well-healed wounds. Fifteen patients had ASR irrespective of the location of the steep meridian. In the other 15, only the suture located in the steep meridian was selectively released. The pattern of decay of astigmatism after suture release was studied using computerized videokeratography. Results: Mean pretreatment corneal cylinder was 6.30 D ± 2.72 (SD) in the ASR group and 6.95 ± 1.67 D in the SSR group. In the ASR group, corneal cylinder dropped to 3.70 ± 1.15 D immediately after suture release and further decreased to 1.82 ± 0.66 D at 1 week (P < .001). In the SSR group, astigmatism swung erratically to the adjoining sutures and decreased unpredictably at an average of 1.32 ± 2.00 D with each suture release. Conclusion: The ASR technique was more predictable and less cumbersome than the SSR method.