Outcomes of Wound Dehiscence Post–Penetrating Keratoplasty

Jenny, F; Rapuano, Christopher J.; Hammersmith, K.M.; Nagra, Parveen K.; Dai, Yang; Azari, Amir A.

doi:10.1097/ico.0000000000000817

Cited by 14 publications

(11 citation statements)

References 27 publications

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“…According to Tran et al, the longest was 20 years [ 13 ]. All traumatic WDs were observed to occur in the corneal graft-host interface [ 3 , 14 ], and our finding is consistent with it. This phenomenon indicated that the tensile strength of corneal graft-host junction after keratoplasty was weaker than original corneal tensile strength.…”

Section: Discussionsupporting

confidence: 90%

Outcomes of Wound Dehiscence after Penetrating Keratoplasty and Lamellar Keratoplasty

Wang

Liu

Zhang

et al. 2018

Journal of Ophthalmology

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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.

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Section: Discussionsupporting

confidence: 90%

Outcomes of Wound Dehiscence after Penetrating Keratoplasty and Lamellar Keratoplasty

Wang

Liu

Zhang

et al. 2018

Journal of Ophthalmology

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“…The amount of leakage from different areas can thus be observed. 2 Other modalities are sometimes also employed to diagnose occult wound leaks, such as ultrasound biomicroscopy as was described by Sicco et al 3 The treatment modality will depend on the type and extent of leakage present. In the presence of a flat anterior chamber, the wound leak should be urgently closed in the operating room.…”

Section: Complications Related To Wound Closurementioning

confidence: 99%

“…In the presence of a flat anterior chamber, the wound leak should be urgently closed in the operating room. 2 The presence of iris prolapse, even in the absence of a flat chamber, which will increase the risk for infection, should also be immediately surgically repaired in the operating room. 4 The urgency is to avoid contamination that could lead to infection, as well as to avoid prolonged contact between the corneal endothelium and other structures, which may ultimately lead to endothelial cell death and graft failure.…”

Section: Complications Related To Wound Closurementioning

confidence: 99%

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Early Complications After Penetrating Keratoplasty

Haidara¹,

Jeng²

2016

US Ophthalmic Review

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Although endothelial keratoplasty has gained increasing popularity over the last decade in the US, penetrating keratoplasty (PK) continues to have a role in the treatment of corneal diseases. This is especially true in developing nations where endothelial keratoplasty has not been popularized, and where isolated endothelial disease is much less common. In these situations, PK is still indicated. As with any surgical procedure, PK carries with it complications that can threaten the success of the procedure, including wound-related issues, ocular surface disease, infections, and suture-related complications. This article will review the various aspects of early complications after PK occurring within the first 2 months of surgery, along with management techniques. A review of the current literature was performed via a Medline search using the keywords “penetrating keratoplasty,” “complications,” “cornea,” and “transplant.” All articles containing descriptions of early postoperative complications after PK were reviewed, and the more commonly encountered complications are discussed in this article.

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“…Dehiscence may occur secondary to traumatic or non-traumatic causes. Human-induced injuries in young patients, or falls in the elderly, account for the majority of traumatic cases,8,12,20 while non-traumatic causes include suture removal, microbial keratitis or spontaneous dehiscence 16,19…”

Section: Introductionmentioning

confidence: 99%

<p>Comparative Evaluation Of Clinical Characteristics And Visual Outcomes Of Traumatic And Non-Traumatic Graft Dehiscence Following Corneal Transplantation Surgery</p>

Stevenson¹,

Abell²,

McGuinness³

et al. 2019

OPTH

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PurposeTo compare patient demographics, clinical associations and visual outcomes between traumatic and non-traumatic wound dehiscence, following corneal transplantation.MethodsRetrospective review of all patients presenting with post-keratoplasty wound dehiscence to the Royal Victorian Eye and Ear Hospital between January 2005 and December 2017. Patients with wound dehiscence following keratoplasty of any cause were included.ResultsOf 71 eyes from 71 patients included, 60 (85%) were penetrating keratoplasty patients. The mean age was 56.4 years (SD=22.7, range 17.6–97) and 62% (n = 44) of patients were male. There were 28 (39%) cases of traumatic dehiscence and 43 (61%) cases of non-traumatic dehiscence. The median time interval from keratoplasty to dehiscence was significantly less in non-traumatic patients than traumatic patients (0.2 years, IQR 0.1–2.0 vs 2.3 years, IQR 0.3–14.8, p=0.01). There was no significant difference in best-corrected visual acuity at 6 months between traumatic and non-traumatic dehiscence (6/60 vs 6/36, p=0.62), suture technique (continuous vs interrupted, p=0.12), or graft type (penetrating keratoplasty vs deep anterior lamellar keratoplasty) after adjusting for keratoconus (p=0.41).ConclusionPost-keratoplasty wound dehiscence is a serious complication and can cause significant loss of vision. While the risk of dehiscence is lifelong, the first 3 years post-keratoplasty carry the highest risk, with non-traumatic dehiscence tending to occur earlier than traumatic dehiscence.

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Outcomes of Wound Dehiscence Post–Penetrating Keratoplasty

Abstract: Wound dehiscence is a lifelong risk after PK regardless of the age, indication for corneal transplant, and time since transplant. A better visual outcome was associated with retained pseudophakia and clear corneas.

Cited by 14 publications

References 27 publications

Outcomes of Wound Dehiscence after Penetrating Keratoplasty and Lamellar Keratoplasty

Outcomes of Wound Dehiscence after Penetrating Keratoplasty and Lamellar Keratoplasty

Early Complications After Penetrating Keratoplasty

<p>Comparative Evaluation Of Clinical Characteristics And Visual Outcomes Of Traumatic And Non-Traumatic Graft Dehiscence Following Corneal Transplantation Surgery</p>

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