Double Running Suturing Preferable to Reduce Astigmatism After Penetrating Keratoplasty

TRUJILLO, PERU – APRIL 18: Corneal edema aphakia patient Jose, aged 87, undergoes surgery at the IRO (Regional Institute for Ophthalmology) on April 18, 2018 in Trujillo, Peru. Following a clinical screening day, Jose was chosen for a penetrating keratoplasty procedure (cornea transplant) during a programme run by Orbis, the ophthalmic training organisation. Founded in 1982 by ophthalmologist David Paton, Orbis trains eyecare teams across Africa, Asia and Latin America to improve the standard of eyecare in the region. As well as working in local hospitals, the charity also has a self-sufficient surgical unit on the Orbis Flying Eye Hospital, a converted McDonald-Douglas MD10 aircraft. (Photo by Leon Neal/Getty Images)
The technique also led to faster visual rehabilitation and lower complication rates than single running and interrupted sutures.

The use of double running suture (DRS) techniques in penetrating keratoplasty (PK) surgery appears to reduce postoperative astigmatism, provide faster visual rehabilitation, and was lower complication rates than techniques featuring single running sutures (SRS) and interrupted sutures (INT), according to research published in Clinical Ophthalmology.

Researchers conducted a prospective study to evaluate the effects of different suturing techniques in penetrating keratoplasty surgery, with the goal of identifying the most efficacious technique in reducing postoperative astigmatism.

Patients underwent PK for different indications. The same surgeon performed all interventions. Patients had at least 12 months of postoperative follow up, and astigmatism, best-corrected visual acuity (BCVA), and complications were evaluated. 

A total of 100 eyes from 100 patients were randomly assigned to 1 of 5 suturing technique groups (n = 20 each): INT, SRS, DRS with 2 10-0 sutures (DRS), double running anti-torque with 2 10-0 sutures (DRSa), DRS with both 10-0 and 11-0 sutures (DRS with 11-0).

Across suturing technique groups, patients had mean ages ranging from 42.86 to 47.82 years. Indications for penetrating keratoplasty included keratoconus, central corneal scarring, pseudophakic bullous keratopathy, Fuch’s endothelial dystrophy, and others.

At 12 months of follow up, mean post-surgical keratometric and topographic astigmatism values were 5.86±1.87 D and 5.95±1.69 D in the INT group, 5.34±1.99 D and 5.62±1.95 D in the SRS group, 3.00±1.38 D and 3.18±1.44 D in the DRS group, 2.89±1.11 D and 3.02±1.27 D in the DRSa and 3.06±1.22 D and 3.12±1.08 D in the DRS with 11-0 group, respectively.  

The team reported that the differences in astigmatism were significantly different between the DRS groups and groups with different techniques (INT and DRS, DRSa, DRS with 11-0, P =.001; SRS and DRS, DRSa, DRS with 11-0, P =.001). No statistically significant differences were observed between the INT and SRS groups (INT and SRS, P =.458) and among the different DRS groups (DRS, DRSa and DRS with 11-0, P =.792). The researchers did not observe any significant differences in BCVA values among the 5 groups. 

The team reported wound leak rates of 10% in the INT group, 5.3% in the SRS group, and 0% in all DRS groups. 

“In penetrating keratoplasty surgery, the double running suture technique can provide better outcomes as it is associated with minor postoperative astigmatism, leads to faster visual rehabilitation, and has a lower complication rate if compared with techniques featuring single running and interrupted sutures,” researchers report.


Nuzzi R, Burato C, Tridico F, Nuzzi A, Caselgrandi P. Advantages of double running sutures in astigmatism after penetrating keratoplasty. Clin Ophthalmol. 2022;16:797-802. doi:10.2147/OPTH.S355538