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    Astigmatism After Cataract Surgery: Nylon Versus Mersilene: Five-Year Data

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    Astigmatism After Cataract Surgery: Nylon Versus Mersilene: Five-Year Data

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    drews1995-3

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    Astigmatism After Cataract Surgery: Nylon Versus Mersilene: Five-Year Data

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    of 3

    Astigmatism after cataract surgery: Nylon

    versus Mersilene
    Five-year data

    Robert C. Drews, M.D.

    ABSTRACT
    This is a follow-up of a previous study that evaluated astigmatism after
    cataract surgery. In that study with a six-month follow-up, there was no
    statistically significant difference in astigmatism between eyes with nylon
    sutures and those with polyester fiber (Mersilene®) sutures. This article
    reports the five-year data on this series of eyes.
    Key Words: astigmatism, cataract surgery, nylon, Mersilene

    Much has been written about wound stability and One patient was excluded from the study because
    astigmatism after cataract surgery. In a prospective she died four months after the surgery on the second
    study, I followed changes in astigmatism for six eye and long-term follow-up could not be obtained.
    months postoperatively and found no statistically sig- One patient died after three years, two died after four
    nificant difference in eyes in which nylon sutures were years, and one was lost to follow-up for the five-year
    used and those in which polyester fiber (Mersilene®) checkup. The other 21 patients were seen on all post-
    sutures were used. 1 operative visits.
    The question remained, however, how much further I did not lyse any of the sutures with a laser or knife.
    astigmatism would shift and if there would be a dif- Rather than cut sutures, I allowed patients with high
    ference after the nylon sutures began to dissolve. This with-the-ru1e astigmatism to engage in early full ac-
    article reports five-year data on the same eyes evalu- tivity; I even encouraged a few to rub their eye lightly.
    ated in the previous study. Nylon sutures began breaking two years after surgery.
    None of the Mersilene sutures broke or had to be
    MATERIALS AND METHODS removed.
    I performed all surgery and follow-up care.
    Twenty-five patients had bilateral cataract surgery.
    The wounds were biplanar, with a vertical groove RESULTS
    made 1.0 mm to 1.5 mm behind the limbus and ex-
    tended horizontally into the anterior chamber. Wound As expected, there was a wide variation in induced
    length (10.0 mm) and technique were the same except astigmatism among eyes, too much to calculate statis-
    that the first eye was closed using 10-0 nylon with two tical significance. Some patients had as much as 6.0
    figure-eight and three interrupted sutures. The second diopters (D) of induced cylinder in the immediate
    eye was closed with four 11-0 Mersilene figure-eight postoperative period. The induced cylinder disap-
    sutures. The 11-0 Mersilene was chosen rather than peared within two to six months.
    10-0 because it has essentially the same strength as On average, a shift in astigmatism began about two
    10-0 nylon. Patients were followed prospectively with years postoperatively for eyes with nylon-sutured
    periodic measurements by manual keratometry and wounds (Figure 1). There was a gradual decrease in
    manifest refraction. the difference between nylon and Mersi1ene over the

    From the Washington University School of Medicine, St. Louis, Missouri.


    Presented at the Symposium on Cataract, IOL and Refractive Surgery, Boston, April 1994.
    Reprint requests to Robert C. Drews, M.D., 211 North Meramec Avenue, Clayton, Missouri 63105.

    70 J CATARACf REFRACf SURG-VOL 21, JANUARY 1995


    Astigmatism (diopters) with- the-rule Astigmatism (diopte rs) with-the-rule
    4 -------.-----------------------------------
    2 3 ----------------------------

    2 ----------------------.---------

    o ~-----~~~*-----~====~------
    - 1 .. ---------------------'10_-----<>-------<1

    -2
    L -_ _~____~____~_ _~____~____~
    -2 L -_ _ ~ _ __ _~_ _ _ _~_ _~_ _ _ _~_ _ _ _~ o 2 34 5 6
    o 2 34 5 6 Years post op
    Years post op
    -e- Nyl on --+- Merslle ne
    --e- Nylon --e- Mers ilene

    Fig. 1. (Drews) Average astigmatism shift (N = 25 eyes). Fig. 3. (Drews) This patient showed a sudden 1.5 D shift
    in astigmatism when her nylon sutures biode-
    graded and began to break at two years.

    five years, beginning three years postoperatively. Even


    up to five years, there was no evidence that the astigmatism be tied in whether nylon or Mersilene is
    wounds were stable; there continued to be very slow used. 1
    against-the-rule shift for both nylon and Mersilene.
    Although one may question whether sutures affect
    wound geometry two years after surgery, in this study
    DISCUSSION there was a shift in astigmatism occasionally when a
    nylon suture broke (Figure 3). In my experience, this
    Unlike nylon, Mersilene sutures are not biodegrad- is not unusual. Even in these cases, however, the
    able. Thus, some surgeons have advocated tying in difference between the amount of astigmatism with
    1.0 D to 1.5 D of against-the-rule astigmatism when nylon and with Mersilene progressively decreased.
    Mersilene is used rather than the usual 2.5 D to 3.0 D One wonders how much difference there will be after
    with nylon closure of a 10.0 mm wound. ten years.
    Occasionally, in patients with a nylon suture in one I have observed rapid astigmatism shifts in some
    eye and Mersilene in the fellow eye, there was a noncompliant patients who insist on vigorous exercise
    significant difference in astigmatism between eyes early after surgery (especially with 10.0 mm wounds)
    (Figure 2), but such instances are sporadic and anec- (Figure 4). I allow greater patient activity and tincture
    dotal. The overall series did not show a significant of time to take care of excessive with-the-rule astig-
    difference, and I have advised that the same amount of matism after cataract surgery. I have cut only one

    Astigmatism (diopters) with- the- rule


    5 -.-- --- -- -.---------- -------------
    Astigmatism (diopters) with- the- rule
    4 --.---.--------.--- 2

    of-----------------------------------

    o ~~~-------====~==~------
    -4 - - - - - - - - - ....---..- -
    -2 - -- - ----=
    -"'!":===~
    -5
    o 2 3 4 5 6 o 2 3 4 5 6
    Years post op Years post op

    --e- Nylon --lI<- Mersilene -e- Nylon --+- Mersi lene

    Fig. 2. (Drews) This patient showed a consistent 2.0 D Fig. 4. (Drews) This patient rubbed his eyes vigorously
    difference between her two eyes, with the Mer- and experienced a dramatic against-the-rule astig-
    silene-sutured wound showing less astigmatic shift matic shift, presumably from wound slippage.
    than the wound sutured with nylon.
    J CATARACT REFRACT SURG-VOL 21, JANUARY 1995 71
    suture to control astigmatism in a cataract wound in Although this study was limited to 10.0 mm
    the past three years. wounds, the long-term changes seen in the study refute
    It is said that wounds do not heal from end to end, claims of wound stability six weeks or even six
    but across the wound. Scars shrink in all directions, months after surgery. Mersilene may provide better
    however, causing wounds to continue to mold and wound stability than nylon after two years.
    shorten not only from side to side but from end to end.
    The end-to-end shortening of a limbal wound may
    induce against-the-rule astigmatism on its own and
    hasten wound slippage for lack of support, contribut- REFERENCE
    ing to the against-the-rule shift. I have been trying to
    measure this shortening, but this has been very 1. Drews RC. Astigmatism after cataract surgery: nylon
    difficult. versus Mersilene. Ophthalmic Surg 1989; 20:695-696

    72 J CATARACT REFRACT SURG-VOL 21, JANUARY 1995

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