Purpose: To assess the changes in corneal power and refraction due to sequential suture removal after penetrating keratoplasty (PK).

Retrospective consecutive case series.

setting: Clinical practice. study population: We studied 67 phakic keratoconus eyes (central excimer laser trephination, primary keratoplasty, graft/recipient diameter 8.1/8.0 mm; double running suture) in this longitudinal study. main outcome measures: Zeiss keratometry (equivalent power (KEQ), astigmatism (KAST)), corneal topography (equivalent power (TEQ), astigmatism (TAST)) and subjective refractometry (spherical equivalent (SEQ), refractive cylinder (RAST)) were assessed with sutures in place (interval 1), with one suture out (interval 2), and with all sutures out (interval 3). observation procedure: Corneal power and refraction was decomposed into vector components and the changes were derived between time stages.

The mean follow-up period was 3.9 ± 1.7 years. At interval 1, the axes of KAST/TAST/RAST were almost randomly distributed. At interval 2, the with/against the rule component of KAST/TAST/RAST decreased slightly and the oblique component increased significantly, so that the axes tended to have a preferred oblique direction. At interval 3, the with/against the rule component of KAST/TAST/RAST increased slightly and the oblique component decreased significantly, so that the with/against the rule component exceeded the oblique component by approximately 23%/28%/25%. Median KEQ/TEQ/SEQ changed by 0.64/0.62/−1.11 diopters (interval 1 to interval 2) and by −0.85/−0.90/1.56 diopters (interval 2 to interval 3).

As a result of removal of the first running suture, corneal astigmatism as well as the refractive cylinder tend to oblique axes. As a result of removal of the second running suture, the final corneal astigmatism and refractive cylinder tend to orientation axes with/against the rule.