Outcomes of Wound Dehiscence after Penetrating Keratoplasty and Lamellar Keratoplasty

Abstract

Objective To investigate the incidence, causes, occurrence time, and range of wound and outcomes of wound dehiscence in patients treated by penetrating keratoplasty (PK) or lamellar keratoplasty (LK). Methods We retrospectively reviewed medical records of keratoplasty in Shandong Eye Hospital from January 2006 to June 2017. Thirty-one eyes of 30 patients had sustained wound dehiscence (WD) after surgical treatment. The surgical type, causes, occurrence time, extent of the wound, treatment, and outcomes were recorded. Results The study population consisted of 26 men and 4 women. The mean age at the occurrence of WD was 44.6 years old (range: 12–78 years), and the mean time from keratoplasty to WD was 45.9 months (range: 1–204 months). WD occurred in 23 eyes (23/1385, 1.66%) after PK and 8 eyes (8/1632, 0.49%) after LK (p < 0.05). Twenty-seven eyes (27/31, 87.0%) had trauma-induced dehiscence. The mean range of dehiscence was 5.5 o'clock. The vision ranged from 20/50 to light perception after wound suture. The eyes receiving LK had fewer serious complications than PK. Conclusions Compared with LK, PK seems to be more prone to result in wound dehiscence. The WD after LK may be less severe. The visual acuity after treatment of WD can be worse in the eyes with PK than LK.

Donor-Recipient Crosslinking-Assisted Manual Deep Anterior Lamellar Keratoplasty: DRXL-DALK

“…In addition to the early and later advantage of stabilizing the wound on both the donor and recipient side preventing spontaneous [30,31] and maybe reducing the consequences of post-traumatic wound dehiscence [32] after keratoplasty, the CDR-ACXL technique performed prior to DALK in our experience has proven to be useful during the trephination phase, which in this case it occurs on a compacted tissue resulting more facilitated and precise.…”

“…A secondary effect of CXL proved by in vivo confocal microscopy is cellular apoptosis and keratocytes repopulation with deposition of new higher resistant collagen fibres and increased resistance against collagenase activity. Some authors have suggested to use CXL in the pre-treatment of corneal graft for the decellularization [29], thus preventing the rejection [30,31]. In our protocol we use the circular donor-recipient bidirectional 9 mW/5.4 J/cm 2 Accelerated CXL [27] and we named this approach proposed by Mazzotta "Circular Donor-recipient Accelerated Crosslinking" or CDR-ACXL and The innovation of our technique consists in applying for the first time a peripheral [25] or annular "doughnuts-shaped" Accelerated 9mW CXL [28] preoperatively in both the donor [23] and the recipient corneas [25] with different timing.…”

Femtosecond laser‐assisted minimally invasive lamellar keratoplasty for the treatment of advanced keratoconus

“…However, sutures may lead to the induction of irregular astigmatism, infection, neovascularization and trauma, although its incidence is relatively low. The incidence of suture-related complications ranges from 1.0% to 10.8% [29][30][31] according to the existing reports. The procedure that eliminates the need for sutures has the potential to improve the outcomes and lower the rates of postoperative complications.…”

Temporary Kerato-Prosthesis to Resolve Traumatic Loss of a Healed Corneal Button

“…Corneal wound healing after keratoplasty is a slow and complex phenomenon. Different studies demonstrated that corneal scar tissue at graft-host interface never regains the same tensile strength as before keratoplasty [6, 7], being decreased by 50% from a normal cornea, as described by Gassett and Dohlman [8]. The graft-host interface becomes an important point of weakness of the cornea [9].…”

“…WD incidence after PKP ranges from 0.6 to 5.8%, and the most important reason is trauma. Tseng et al [ 10 ] described a possible correlation between WD incidence and age, with older people more affected than younger although Wang et al [ 7 ] did not find a correlation with age. Rehany and Rumelt [ 11 ] reported traumatic WD to be more common in younger individuals and especially in those who had undergone keratoplasty for keratoconus.…”