Effect of the timing of corneal suture removal after phacoemulsification on post-operative astigmatism

PURPOSE: To evaluate the effect of corneal suture removal timing after phacoemulsification on refractive and corneal astigmatism and best-corrected visual acuity (BCVA).
METHODS: This prospective, single-center comparative study included 34 patients (34 eyes, aged 40–60 years). All eyes underwent uncomplicated phacoemulsification through a 2.75-mm superior corneal incision closed with a single 10-0 nylon suture. Patients were randomized into two groups: Suture removal at 1 week (Group 1) or at 1 month (Group 2). Refractive astigmatism, keratometric astigmatism, and BCVA were evaluated immediately before suture removal and at 1 h, 1 week, and 1 month afterward.
RESULTS: Baseline characteristics were similar between groups (p>0.05), and no wound-related complications occurred. In Group 1, refractive astigmatism decreased significantly from 2.18±0.87 D to 0.88±0.42 D at 1 month after suture removal (p<0.001), with most of the reduction occurring within the first post-operative week. In Group 2, refractive astigmatism showed only a minimal change and did not reach statistical significance (1.61±0.68 D to 1.31±0.53 D; p=0.057). Corneal astigmatism reduction was also more pronounced in Group 1. At 1 month, Group 1 demonstrated significantly lower refractive astigmatism than Group 2. (p=0.037) Vector analysis further supported these findings. The early removal group demonstrated significantly greater surgically induced astigmatism correction (SIA 1.68±0.51 D vs. 1.43±0.54 D; p=0.041) and a lower difference vector (0.49±0.28 D vs. 0.77±0.31 D; p=0.012), indicating more effective reduction of suture-induced astigmatism.
CONCLUSION: Early corneal suture removal after cataract surgery provides a faster and greater reduction in post-operative astigmatism and accelerates visual rehabilitation. When wound stability is adequate, suture removal at approximately 1 week post-operatively may be recommended to optimize early refractive outcomes.

Keywords: Astigmatism, Corneal suture removal timing, Corneal suture, Phacoemulsification