Traumatic wound dehiscence after corneal keratoplasty

Abstract

Purpose: To assess patient characteristics, risk factors, outcomes, and the treatment of wound dehiscence (WD) in patients after corneal keratoplasty. Methods: Retrospective chart review of 11 eyes of 11 patients with corneal grafts who underwent repair of WD from January 1, 2004 to December 31, 2012 at Hospital Oftalmologico de Brasilia. Results: Eight (72.7%) patients were men and three were women. Six (54.5%) patients had deep anterior lamellar keratoplasty (DALK) and 5 had penetrating keratoplasty. The mean age at trauma was 31.1 years. The mean time from corneal keratoplasty to WD was 12.82 months (range, 3-33 months). The mean best-corrected visual acuity of patients before trauma was 20/60 (0.48 logMAR) and after final treatment was 20/160 (0.90 logMAR) (P=0.15). In one case, visual acuity decreased to no light perception because of retinal detachment and phthisis bulbi. Accidental blunt trauma and fall were the most common causes of WD. Conclusion: Patients who undergo corneal keratoplasty have a life-long risk of WD. The full-thickness rupture at the graft-host junction in our study suggests that the junction remains vulnerable, even following DALK, and can rupture with trauma. In our series, depending upon the severity of the trauma, postkeratoplastic WD can be associated with a good visual prognosis.

Outcomes of Wound Dehiscence after Penetrating Keratoplasty and Lamellar Keratoplasty

“…An experimental investigation disclosed that the junction after corneal transplantation could never return to normal intensity. In addition, increasing evidence indicated that WD was a lasting risk in all patients undergoing keratoplasty, regardless of their age, the type of operation, indication for surgery, and time to dehiscence after corneal transplantation [ 15 ]. Therefore, such patients should pay attention to take long-term protective measures such as wearing safety glasses.…”

<p>Finite Element Analysis of Air Gun Impact on Post-Keratoplasty Eye</p>

“…Globe rupture in eyes treated by corneal transplantation is a serious-clinical condition that may result in loss of vision. 1,2 Several studies have reported the clinical outcome, incidence and causes of trauma in cases of globe rupture after keratoplasty. [1][2][3][4][5][6][7][8][9][10] The incidence of traumatic globe dehiscence after penetrating keratoplasty (PKP) has been reported to be 0.23-5.8%.…”

“…1,2 Several studies have reported the clinical outcome, incidence and causes of trauma in cases of globe rupture after keratoplasty. [1][2][3][4][5][6][7][8][9][10] The incidence of traumatic globe dehiscence after penetrating keratoplasty (PKP) has been reported to be 0.23-5.8%. 3,5,[8][9][10] Keratoplasty exposes patients to a higher risk of globe rupture because the surgical wound may never regain the strength and stability of an intact cornea.…”

“…3,5,[8][9][10] Keratoplasty exposes patients to a higher risk of globe rupture because the surgical wound may never regain the strength and stability of an intact cornea. 1 The major types of trauma causing globe rupture in the post-PKP eye are: being accidentally struck by an object (33%) or child (13%), intentional trauma (20%) and falls (13%). 3 In other studies, major causes of globe rupture in eyes undergoing keratoplasty were falls in elderly patients followed by blunt trauma, from a branch, airbag, fist or finger.…”

“…3 In other studies, major causes of globe rupture in eyes undergoing keratoplasty were falls in elderly patients followed by blunt trauma, from a branch, airbag, fist or finger. 1,5 Due to the mechanical vulnerability of eyes that undergo keratoplasty, it is clinically important to evaluate the corneal wound strength against blunt impact, and the risk of traumatic wound dehiscence. However, it is difficult to evaluate strain strength property of the post-keratoplasty eye, because an apparatus for measuring mechanical features of the eye has not been developed or introduced in clinical ophthalmology, and the possibility of tissue damage by these tests cannot be excluded, especially in a clinical situation.…”