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EW INTERNATIONAL 102 October 2017 by Stefanie Petrou Binder, MD, EyeWorld Contributing Writer corrections needed for about 2 years with a postoperative visual acuity of 20/25. After 2 years, however, their vision begins to change. Those who we fit with contacts stayed stable for 6 years and more." A retrospective consecutive case series performed by Dr. Nose investigated the visual and refractive changes observed after double con- centric corneal modified Greene's lasso sutures to correct hyperopic shift after RK. 4 The case series com- prised 17 eyes of 15 patients, and all of the surgeries were performed by Dr. Nose between 2000 and 2003. The spherical equivalent was reduced from +4.38 ± 2.87 D preop- eratively to –0.54 ± 2.59 D postop- eratively, at the last postoperative follow-up (P<.001). No statistically significant difference was observed in mean refractive astigmatism before and after the corneal suture (P=.15). Seven patients (41.2%) gained at least two Snellen lines of BCVA, strictly resulting from the ef- fect of the sutures. The sutures were performed 11.6 ± 3.2 years after the original RK, and the mean follow-up time was 20.3 ± 11.3 months. One eye (5.9%) lost two Snellen lines of BSCVA. "One hundred percent of the eyes were able to fit contact lenses, which is one of the most important outcomes, as this is virtually impos- sible before the suturing because the cornea is too flat," Dr. Francesconi corneas with our modified suturing technique and improve even high degrees of hyperopia, as associated with irregular astigmatism and open incisions," Dr. Francesconi said. The tweak Greene's lasso suture has been im- plemented to revise overcorrections resulting from RK. 2 It involves two intrastromal sutures passed in purse- string fashion 3 around the central cornea that get tied down tightly in order to vault the anterior cornea and induce myopia. According to Dr. Francesconi, one of the biggest problems with these techniques is the loss of corneal curvature over time due to the central sliding of the suture. A modified version of these two techniques fixates the suture, which helps stop central suture sliding and consequently progressive corneal flattening. "By passing the needle over the incision, instead of into it, Dr. Nose could zigzag over the whole cornea to create a circular suture," Dr. Fran- cesconi said. "The first suture was usually in the 7-mm optical zone and the second one parallel to it, at around 9 mm. He did not suture inside the incision, as the lasso or the purse-string sutures would, and once the suture was knotted, it did not slide inside the optical zone. Many of our patients did not require contact lenses. We observed that vision stayed stable with no further Claudia Francesconi, MD, Department of Ophthalmology, Uni- versidade Federal de São Paulo (UNI- FESP), São Paulo, Brazil, spoke on be- half of her colleague, Walton Nose, MD, UNIFESP, as part of a session titled "Symposium of Challenging Cases," sponsored by the Brazilian Association of Cataract & Refractive Surgery (BRASCRS). "To address the continuous flattening of the cor- nea following RK, several surgeries were studied, like the lasso and purse-string sutures. Suture remod- elations after incisional surgery are not just to correct irregularities, but physicians can correct RK-induced hyperopia and improve corneal asphericity. Dr. Nose was successful in finding a way to modify the lasso suture for these difficult cases. We saw that we could stabilize these Brazilian surgeon tweaks Greene's lasso suture for corneal remodeling in RK patients R adial keratotomy (RK) has been proven to eliminate distance spectacle depen- dence in roughly 70% of myopic patients. 1 How- ever, the positive visual effects are skewed over time by a hyperopic shift caused by a continued central flattening of the cornea. Innovative suturing techniques were presented at the 2017 ASCRS•ASOA Sympo- sium & Congress that were not only effective in remodeling the corneal curvature in post-RK patients, but also allowed contact lens wear. Getting the cornea to curve Presentation spotlight Keep up on the latest in ophthalmology! Follow EyeWorld on Twitter at twitter.com/EWNews Are you a fan of EyeWorld? Like us on Facebook at: facebook.com/EyeWorldMagazine Find us on social media " The study concluded that corneal sutures could be used to correct RK-induced hyperopia and improve corneal asphericity in an attempt to stabilize these corneas. " —Claudia Francesconi, MD

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